Organization
BERTACCHI & ASSOCIATES, PC
Active
Other names
SPORTMED
Organization subpart
No
Provider details
NPI number
Authorized official
PETER LA ROY BERTACCHI MD (MEDICAL DIRECTOR)
(203) 359-2042
Entity
Organization
Contact information
Practice address
276 HIGH RIDGE RD, STAMFORD, CT 06905-3013
(203) 359-2042
(203) 359-2082
Mailing address
276 HIGH RIDGE RD, STAMFORD, CT 06905-3013
(203) 359-2042
(203) 359-2082
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
034033
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C03151
MEDICARE GROUP NUMBER
CT
Enumeration date
11/30/2006
Last updated
01/23/2008
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