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General NPI Number Information
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NPI Number | 1003051905
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Entity Type | Organization
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Legal Business Name | AMSTERDAM ORTHOPEDICS, CHARLES J BERTUCH,JR,MD,PC
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Dates
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Enumeration Date | 12/05/2008
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Last Update Date | 12/05/2008
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Provider Practice Location Address
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Address Line | 124 POLAR PLZ ROUTE 30 NORTH
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City | AMSTERDAM
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State | NY
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Zip | 12010-1610
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Country | US
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Telephone | 518-843-2292
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Fax | 518-843-1515
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Provider Business Mailing Address
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Address Line | 124 POLAR PLZ ROUTE 30 NORTH
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City | AMSTERDAM
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State | NY
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Zip | 12010-1610
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Country | US
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Telephone | 518-843-2292
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Fax | 518-843-1515
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES J BERTUCH JR.
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Credential | M.D.
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Telephone | 518-843-2292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 99421-1
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License Number State | NY
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