Provider Demographics
NPI:1023764818
Name:ORTIZ, ERWIN MANUEL
Entity type:Individual
Prefix:
First Name:ERWIN
Middle Name:MANUEL
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MUIR PL
Mailing Address - Street 2:
Mailing Address - City:VAUXHALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07088-1020
Mailing Address - Country:US
Mailing Address - Phone:973-943-6989
Mailing Address - Fax:
Practice Address - Street 1:4 MUIR PL
Practice Address - Street 2:
Practice Address - City:VAUXHALL
Practice Address - State:NJ
Practice Address - Zip Code:07088-1020
Practice Address - Country:US
Practice Address - Phone:973-943-6989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities