Healthcare Provider Details

I. General information

NPI: 1568821916
Provider Name (Legal Business Name): BERTEKAP SURGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2016
Last Update Date: 02/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 COMANCHE DR
OCEANPORT NJ
07757-1603
US

IV. Provider business mailing address

113 COMANCHE DR
OCEANPORT NJ
07757-1603
US

V. Phone/Fax

Practice location:
  • Phone: 732-749-0827
  • Fax:
Mailing address:
  • Phone: 732-749-0827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number26NR16375200
License Number StateNJ

VIII. Authorized Official

Name: MR. GERALD BERTEKAP
Title or Position: PRESIDENT
Credential:
Phone: 732-749-0827