Provider Demographics
NPI:1780028621
Name:BORTEL, JESSICA LEE (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:BORTEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1010 E AND WEST RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3602
Mailing Address - Country:US
Mailing Address - Phone:716-677-7109
Mailing Address - Fax:
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:ECMC, #1184-A
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-4221
Practice Address - Fax:716-898-4538
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2828292084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry