Healthcare Provider Details

I. General information

NPI: 1992146872
Provider Name (Legal Business Name): YURIY BORTNIK NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 BRIGHTON 11TH ST
BROOKLYN NY
11235-5327
US

IV. Provider business mailing address

PO BOX 350710
BROOKLYN NY
11235-0710
US

V. Phone/Fax

Practice location:
  • Phone: 347-200-0024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License Number635019
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF402243
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: