Healthcare Provider Details

I. General information

NPI: 1013352491
Provider Name (Legal Business Name): BERTRAND TOULOUSE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W 97TH ST
NEW YORK NY
10025-6450
US

IV. Provider business mailing address

110 W 97TH ST
NEW YORK NY
10025-6450
US

V. Phone/Fax

Practice location:
  • Phone: 212-749-1820
  • Fax: 212-932-8323
Mailing address:
  • Phone: 212-749-1820
  • Fax: 212-932-8323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number22613716
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: