Eric Max Bortnick, M.D.

Primary specialty

Pediatric Urology PhysicianTaxonomy code 2088P0231X

License

77347 Issued in CT

Practice address

789 Howard Ave # Fmp309
New Haven, CT 06519-1304

Phone

(203) 785-7671

NPI assigned

Mar 28, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ebortnick34196@direct.bostonchildrens.org
• Direct secure messaging: ebortnick676523@direct.ynhh.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Yale University

  • Anesthesiology Physician
  • New Haven, CT
  • NPI 1205822236

  Single Specialty

  Medicare reassignment NPD
• Yale University

  • Adult Mental Health Clinic/Center
  • Hamden, CT
  • NPI 1134391824
  NPD
• Yale University

  • Durable Medical Equipment & Medical Supplies
  • Fairfield, CT
  • NPI 1548066962
  NPD

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

{
    "created_epoch": "1459123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1477915437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "789 HOWARD AVE # FMP309",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065191304",
            "telephone_number": "203-785-7671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "789 HOWARD AVE # FMP309",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065191304",
            "telephone_number": "203-785-7671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORTNICK",
        "first_name": "ERIC",
        "middle_name": "MAX",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-28",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology, Pediatric Urology",
            "state": "CT",
            "license": "77347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marissa Borgese, MD, MS
• Nathaniel I Borochov, MD
• Margaret Boron, MD
• Mark R Boroski, LMFT,LADC, MA,BS
• Lauren Anne Borsavage
• Satrajit Bose, M.D.
• Sophia Gabrielle Bosque
• Rebecca G Boswell, PHD
• Lucas Giovanni Botello
• Welathanthrige Savindu Pasan Botheju, MD

• Pediatric Urology Physician in New Haven, CT
• Providers in New Haven, CT by specialty
• Pediatric Urology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.