Healthcare Provider Details

I. General information

NPI: 1700095106
Provider Name (Legal Business Name): BILLIE JEAN BERTRAND PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEST STREET 10TH FLOOR
NEW YORK NY
10282
US

IV. Provider business mailing address

200 WEST STREET 10TH FLOOR
NEW YORK NY
10282
US

V. Phone/Fax

Practice location:
  • Phone: 212-357-6339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: