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General NPI Number Information
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NPI Number | 1225333123
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Entity Type | Organization
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Legal Business Name | DAVID M. BORTNICK, PHD. PSYD. PA
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Dates
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Enumeration Date | 01/24/2011
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Last Update Date | 03/15/2013
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Provider Practice Location Address
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Address Line | 1130 SE 18TH PLACE
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City | OCALA
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State | FL
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Zip | 34471-5422
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Country | US
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Telephone | 352-390-6656
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Fax | 352-390-8756
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Provider Business Mailing Address
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Address Line | 1130 SE 18TH PLACE
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City | OCALA
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State | FL
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Zip | 34471-5422
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Country | US
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Telephone | 352-390-6656
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Fax | 352-390-8756
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Authorized Official
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Title or Position | CEO
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Name | DR. DAVID M. BORTNICK
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Credential | PHD., PSYD, PA
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Telephone | 352-390-6656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | FLPY2065
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License Number State | FL
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