| David M Bortnick Phd Psy D Pa | |
|
1750 Tree Blvd Ste 5 St Augustine FL 32084-5719 | |
| (904) 342-0672 | |
| (904) 342-0673 |
| Full Name | David M Bortnick Phd Psy D Pa |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 1750 Tree Blvd Ste 5, St Augustine, Florida |
| Authorized Official Name and Position | David M Bortnick (OWNER PRESIDENT) |
| Authorized Official Contact | 9043921687 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| David M Bortnick Phd Psy D Pa Po Box 3123 St Augustine FL 32085-3123 Ph: () - | David M Bortnick Phd Psy D Pa 1750 Tree Blvd Ste 5 St Augustine FL 32084-5719 Ph: (904) 342-0672 |
| NPI Number | 1225560949 |
|---|---|
| Provider Enumeration Date | 03/31/2017 |
| Last Update Date | 01/06/2020 |
| Certification Date | 01/06/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225560949 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | PY2065 (Florida) | Primary |
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