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NPI Code Detail

MEDICARE: ANDREA TEIXEIRA BORTOT MD

MEDICARE: ANDREA TEIXEIRA BORTOT MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12080A0000XPediatric Adolescent Medicine Physician228661NY

General Provider Information

NPI Number : 1073509493
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA TEIXEIRA BORTOT MD
Provider Business Mailing Address
First Line : 977 48TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11219-2919
Country : US
Telephone Number : 718-283-8015
Fax Number : 718-635-7235
Provider Business Practice Location Address
First Line : 1301 57TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11219-4636
Country : US
Telephone Number : 718-283-3640
Fax Number : 718-635-7235
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2005
Last Update Date : 07/08/2007

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