Provider Demographics
NPI:1326200106
Name:BORTNICHAK, PAULA M (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:M
Last Name:BORTNICHAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 OCEAN AVE N
Mailing Address - Street 2:C13
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-7589
Mailing Address - Country:US
Mailing Address - Phone:201-919-8068
Mailing Address - Fax:
Practice Address - Street 1:51 SOUTH ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-8106
Practice Address - Country:US
Practice Address - Phone:201-919-8068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04744500202C00000X, 2084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry