Basic Information
| Provider Information | |||||||||
| NPI: | 1730229303 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERTISCH | ||||||||
| FirstName: | MAGGIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 355 W 52ND ST | ||||||||
| Address2: | 8TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100196239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6467542100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 355 W 52ND ST | ||||||||
| Address2: | 8TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100196239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6467542100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 02/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 60241669 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.