Provider Demographics
NPI:1588890156
Name:ORTIZ, JOSE JUAN (COTA)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:JUAN
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3140 GODWIN TERRACE
Mailing Address - Street 2:APT E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5469
Mailing Address - Country:US
Mailing Address - Phone:646-261-6160
Mailing Address - Fax:347-427-0510
Practice Address - Street 1:3140 GODWIN TERRACE
Practice Address - Street 2:APT E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5469
Practice Address - Country:US
Practice Address - Phone:646-261-6160
Practice Address - Fax:347-427-0510
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY002850-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant