Provider Demographics
NPI:1619056686
Name:BERTONE, DAVID (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:BERTONE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 NEWMAN SPRINGS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1541
Mailing Address - Country:US
Mailing Address - Phone:732-747-1262
Mailing Address - Fax:732-747-1292
Practice Address - Street 1:732 NEWMAN SPRINGS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1541
Practice Address - Country:US
Practice Address - Phone:732-747-1262
Practice Address - Fax:732-747-1292
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00442600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ025605N11Medicare ID - Type Unspecified