Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 198830-1 | NY |
NPI | 1003805128 |
---|---|
Provider Name | Gerald James Ortiz |
First Address | Amsterdam, NY 12010-7532 |
Second Address | Amsterdam, NY 12010-7532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 28/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01558158 | (05) | NY |
F84277 | (02) | NY |