Basic Information
Provider Information | |||||||||
NPI: | 1255770699 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ORMAZABAL | ||||||||
FirstName: | OLATZ | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4422 3RD AVE | ||||||||
Address2: | DEPT OF INTERNAL MED MILLS 3RD FL | ||||||||
City: | BRONX | ||||||||
State: | NY | ||||||||
PostalCode: | 104572545 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7189606202 | ||||||||
FaxNumber: | 7189603486 | ||||||||
Practice Location | |||||||||
Address1: | 2422 CENTRAL PARK AVE | ||||||||
Address2: |   | ||||||||
City: | YONKERS | ||||||||
State: | NY | ||||||||
PostalCode: | 107101125 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9147792995 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/19/2013 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 287605 | NY | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.