Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 108841 | NY |
NPI | 1942244512 |
---|---|
Provider Name | Dr. Paul Joseph Ort |
First Address | New York, NY 10010-6302 |
Second Address | New York, NY 10010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B78589 | (02) | NY |