Provider Demographics
NPI:1285051896
Name:BERTOLINO, ELENA
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:BERTOLINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WHIPPOORWILL RD
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-1027
Mailing Address - Country:US
Mailing Address - Phone:202-365-3837
Mailing Address - Fax:
Practice Address - Street 1:1800 ORLEANS ST STE 6320
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-4904
Practice Address - Country:US
Practice Address - Phone:410-955-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR113854363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care