David M Bortnick PHD Psy D PA

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PY2065 Issued in FL

Legal business name

DAVID M BORTNICK PHD PSY D PA

Practice address

1750 Tree Blvd Ste 5
St Augustine, FL 32084-5719

Phone

(904) 342-0672

Fax

(904) 342-0673

NPI assigned

Mar 31, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. David M Bortnick, PHD PSYD ABN

Title

Owner President

Phone

(904) 392-1687

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578268800000",
    "number": "1225560949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3123",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320853123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 TREE BLVD STE 5",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320845719",
            "telephone_number": "904-342-0672",
            "fax_number": "904-342-0673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID M BORTNICK PHD PSY D PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-31",
        "last_updated": "2020-01-06",
        "certification_date": "2020-01-06",
        "status": "A",
        "authorized_official_last_name": "BORTNICK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "904-392-1687",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD PSYD ABN"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "FL",
            "license": "PY2065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morgan Dale Dashiell
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• David B. Tuchinsky, D.C., PLLC
• David J Gross MD PA
• David M Feazell PHD P a
• Alberto G David, D.M.D.
• James David, BA
• Maria Teresa David, D.O.
• Alexandria Davidson, RBT

• Clinical Neuropsychologist in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Clinical Neuropsychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.