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Individual
DR. CHARLES JOSEPH BERTUCH JR.
Active
Individual
DR. CHARLES JOSEPH BERTUCH JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
99421-1
NY
202C00000X
Independent Medical Examiner Physician
Primary
099426
NY
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
DR.0052261
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000CM0523
RAILROAD MEDICARE
—
01
—
000405418002
BSH NE NY
NY
05
—
00553493
—
NY
01
—
18111
MVP HEALTHPLAN
NY
Enumeration date
08/29/2006
Last updated
05/03/2019
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