Provider Demographics
NPI:1073597902
Name:ORTIZ, YAEL A (DDS)
Entity type:Individual
Prefix:
First Name:YAEL
Middle Name:A
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 THIRD AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2206
Mailing Address - Country:US
Mailing Address - Phone:212-289-6650
Mailing Address - Fax:212-289-0280
Practice Address - Street 1:2265 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2231
Practice Address - Country:US
Practice Address - Phone:212-289-6650
Practice Address - Fax:212-289-0280
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046385122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
521860379OtherAETNA
13058OtherCIGNA
521860379OtherDELTA DENTAL
DG26TH521860379-2-00OtherCAREFIRST
0017022OtherDORAL
054635OtherJHHC
MD119591300Medicaid
MD288504201Medicaid
521860379OtherMETLIFE
MD288504201Medicaid