| Doctor Name: | DR. JEAN NERVA DORTILUS |
| NPI Number: | 1063658524 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 246264 |
| Business Practice Address: | 481 Main St Suite 301 New Rochelle, NY - 108016324 |
| Business Phone Number: | 9179758444 |
| Business Fax Number: | |
| Mailing Address: | 40 Memorial Hwy, Apartment # 25c NEW ROCHELLE |
| State: | NY |
| Postal Code: | 108018312 |
| Phone Number: | 9179758444 |
| Fax Number: | |
| NPI Enumeration Date: | 01/05/2009 |
| NPI Last Update Date: | 12/22/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 246264 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |