Provider Demographics
NPI:1740396191
Name:BERTERO, GEORGE J JR (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:J
Last Name:BERTERO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3333 HENRY HUDSON PKWY
Mailing Address - Street 2:APT 10H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:718-549-5053
Mailing Address - Fax:718-884-2818
Practice Address - Street 1:697 W END AVE APT 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6919
Practice Address - Country:US
Practice Address - Phone:718-549-5053
Practice Address - Fax:718-884-2818
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2013-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY154900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY40D631Medicare PIN
A62639Medicare UPIN