Provider Demographics
NPI:1558349639
Name:ALPERT, BERTRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BERTRAM
Middle Name:
Last Name:ALPERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1366 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3907
Mailing Address - Country:US
Mailing Address - Phone:718-273-3400
Mailing Address - Fax:718-727-3402
Practice Address - Street 1:1366 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3907
Practice Address - Country:US
Practice Address - Phone:718-273-3400
Practice Address - Fax:718-727-3402
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127460207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00352621Medicaid
NY04A481Medicare ID - Type Unspecified
B80539Medicare UPIN