Provider Demographics
NPI:1568821916
Name:BERTEKAP SURGICAL LLC
Entity Type:Organization
Organization Name:BERTEKAP SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTEKAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-749-0827
Mailing Address - Street 1:113 COMANCHE DR
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1603
Mailing Address - Country:US
Mailing Address - Phone:732-749-0827
Mailing Address - Fax:
Practice Address - Street 1:113 COMANCHE DR
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1603
Practice Address - Country:US
Practice Address - Phone:732-749-0827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-14
Last Update Date:2016-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR16375200163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty