Provider Demographics
NPI:1780102921
Name:BORTZ, AARON
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:BORTZ
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 1:64 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2220
Mailing Address - Country:US
Mailing Address - Phone:516-426-5661
Mailing Address - Fax:
Practice Address - Street 1:13030 180TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-4108
Practice Address - Country:US
Practice Address - Phone:718-527-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health