Provider Demographics
NPI:1902972979
Name:ORTIZ, CARLOS ADOLFO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ADOLFO
Last Name:ORTIZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:142-42 A 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-939-8440
Mailing Address - Fax:718-939-5378
Practice Address - Street 1:142-42 A 41ST AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-939-8440
Practice Address - Fax:718-939-5378
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY186079208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
186079OtherLICENSE NUMBER
NY01336745Medicaid
NYBO2809309OtherDEA NUMBER
NY46-1084637OtherTAX EMPLOYER ID NUMBER