Provider Demographics
NPI:1578742771
Name:BERTUCCINI, CHRISTOPHER M (MPT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:M
Last Name:BERTUCCINI
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Gender:M
Credentials:MPT
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Mailing Address - Street 1:4175 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7639
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:176 ROUTE 70
Practice Address - Street 2:SUITE 10 THE MEDFORD CENTER
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8704
Practice Address - Country:US
Practice Address - Phone:609-714-7733
Practice Address - Fax:609-714-7750
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2012-03-01
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Provider Licenses
StateLicense IDTaxonomies
NJ40QA00905600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist