Healthcare Provider Details

I. General information

NPI: 1487939872
Provider Name (Legal Business Name): CHRISTOPHER J BERTINO MPAS, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RIVER RD BLDG 43
SCHENECTADY NY
12345-8309
US

IV. Provider business mailing address

1 RIVER RD
SCHENECTADY NY
12345-6000
US

V. Phone/Fax

Practice location:
  • Phone: 518-385-7011
  • Fax:
Mailing address:
  • Phone: 518-385-7011
  • Fax: 518-385-3797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number015229-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: