Provider Demographics
NPI:1275105918
Name:BERTOLINI, THOMAS JR
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:BERTOLINI
Suffix:JR
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 1:8200 SHORE FRONT PKWY APT 3A
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-2133
Mailing Address - Country:US
Mailing Address - Phone:917-453-0299
Mailing Address - Fax:718-514-6166
Practice Address - Street 1:8200 SHORE FRONT PKWY APT 3A
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-2133
Practice Address - Country:US
Practice Address - Phone:917-453-0299
Practice Address - Fax:718-514-6166
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health