Healthcare Provider Details

I. General information

NPI: 1780102921
Provider Name (Legal Business Name): AARON BORTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13030 180TH ST
JAMAICA NY
11434-4108
US

IV. Provider business mailing address

64 MEADOW DR
WOODMERE NY
11598-2220
US

V. Phone/Fax

Practice location:
  • Phone: 718-527-2200
  • Fax:
Mailing address:
  • Phone: 516-426-5661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: