Provider Demographics
NPI:1003051905
Name:AMSTERDAM ORTHOPEDICS, CHARLES J BERTUCH,JR,MD,PC
Entity Type:Organization
Organization Name:AMSTERDAM ORTHOPEDICS, CHARLES J BERTUCH,JR,MD,PC
Other - Org Name:CHARLES J BERTUCH, JR, MD, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERTUCH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:518-843-2292
Mailing Address - Street 1:124 POLAR PLZ
Mailing Address - Street 2:ROUTE 30 NORTH
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1610
Mailing Address - Country:US
Mailing Address - Phone:518-843-2292
Mailing Address - Fax:518-843-1515
Practice Address - Street 1:124 POLAR PLZ
Practice Address - Street 2:ROUTE 30 NORTH
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1610
Practice Address - Country:US
Practice Address - Phone:518-843-2292
Practice Address - Fax:518-843-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY99421-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0000CM0523OtherRAILROAD MEDICARE
NY00553493Medicaid
NY33690AMedicare PIN
NY0000CM0523OtherRAILROAD MEDICARE
NY33690BMedicare PIN
NY0471830001Medicare NSC