Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 25MA09880500 | NJ |
NPI | 1083831325 |
---|---|
Provider Name | Stuart A Ort |
First Address | Tarrytown, NY 10591-5139 |
Second Address | Iselin, NJ 17033-2360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 01/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25MA09880500 | LICENSE (01) | NJ |