Provider Demographics
NPI:1720554546
Name:BERTIN, ENGELBERT (NP)
Entity Type:Individual
Prefix:MR
First Name:ENGELBERT
Middle Name:
Last Name:BERTIN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13028 222ND ST
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1240
Mailing Address - Country:US
Mailing Address - Phone:347-528-2130
Mailing Address - Fax:718-276-4508
Practice Address - Street 1:13028 222ND ST
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-1240
Practice Address - Country:US
Practice Address - Phone:347-528-2130
Practice Address - Fax:718-276-4508
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341684-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner