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General NPI Number Information
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NPI Number | 1508116823
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Entity Type | Individual
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Provider Name | KEITH BORTNIKER D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2012
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 2 CROSFIELD AVE STE 302
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City | WEST NYACK
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State | NY
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Zip | 10994-2218
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Country | US
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Telephone | 845-358-2844
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Fax | 845-358-0528
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Provider Business Mailing Address
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Address Line | 59 S CONSTITUTION DR
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City | TAPPAN
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State | NY
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Zip | 10983-1622
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | NY-N006715-1
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License Number State | NY
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