Provider Demographics
NPI:1942251095
Name:BORTZ, JOHN G (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:G
Last Name:BORTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:811 NORTH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603
Mailing Address - Country:US
Mailing Address - Phone:914-686-0006
Mailing Address - Fax:914-686-2660
Practice Address - Street 1:811 NORTH BROADWAY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603
Practice Address - Country:US
Practice Address - Phone:914-686-0006
Practice Address - Fax:914-686-2660
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146082207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0108602Medicaid
D02336Medicare UPIN
NY01F561Medicare PIN