Active NPI
Iluminado Ortanez, M.D.
- Psychiatry Physician
- Princeton, NJ
National Provider Identifier
1154415222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 25MA02778500
- Practice address
- 905 Herrontown Rd
Princeton House Behavioral Health
Princeton, NJ 08540-1901 - Phone
- (609) 497-3300
- Fax
- (609) 497-3370
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 25MA02778500 | NJ | Primary |
Addresses
Primary practice location
905 Herrontown Rd
Princeton House Behavioral Health
Princeton, NJ 08540-1901
Mailing address
3626 US Highway 1
Princeton, NJ 08540-5922
Phone (609) 243-0445
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2205009 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Washington Psychological Services | Psychiatry | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154415222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3626 US HIGHWAY 1",
"city": "PRINCETON",
"state": "NJ",
"postal_code": "085405922",
"telephone_number": "609-243-0445",
"fax_number": "609-452-7577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "905 HERRONTOWN RD",
"address_2": "PRINCETON HOUSE BEHAVIORAL HEALTH",
"city": "PRINCETON",
"state": "NJ",
"postal_code": "085401901",
"telephone_number": "609-497-3300",
"fax_number": "609-497-3370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ORTANEZ",
"first_name": "ILUMINADO",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NJ",
"license": "25MA02778500",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2205009",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Princeton, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.