Healthcare Provider Details

I. General information

NPI: 1134413826
Provider Name (Legal Business Name): MICHAEL P. BERNSTEIN, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 HAZARD AVE SUITE 204
ENFIELD CT
06082-4571
US

IV. Provider business mailing address

146 HAZARD AVE SUITE 204
ENFIELD CT
06082-4571
US

V. Phone/Fax

Practice location:
  • Phone: 860-763-3243
  • Fax: 860-763-3244
Mailing address:
  • Phone: 860-763-3243
  • Fax: 860-763-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number027001
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000396
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number000396
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number000396
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number000396
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number000396
License Number StateCT
# 7
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number000396
License Number StateCT
# 8
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number000396
License Number StateCT

VIII. Authorized Official

Name: DR. MICHAEL P BERNSTEIN
Title or Position: OWNER
Credential: M.D.
Phone: 860-763-3243