Provider Demographics
NPI:1548408321
Name:BERTIE, JAMES STEPHEN (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STEPHEN
Last Name:BERTIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 BAYSWATER CT
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1605
Mailing Address - Country:US
Mailing Address - Phone:718-839-0946
Mailing Address - Fax:
Practice Address - Street 1:3217 BAYSWATER CT
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1605
Practice Address - Country:US
Practice Address - Phone:718-839-0946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine