Provider Demographics
NPI:1619429958
Name:TROTSKY, BERNARD
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:
Last Name:TROTSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-4011
Mailing Address - Country:US
Mailing Address - Phone:978-531-0767
Mailing Address - Fax:978-531-1012
Practice Address - Street 1:119R FOSTER ST BLDG 13
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-5975
Practice Address - Country:US
Practice Address - Phone:978-531-0767
Practice Address - Fax:978-531-1012
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator