Healthcare Provider Details

I. General information

NPI: 1003479221
Provider Name (Legal Business Name): PAUL BERNSTEIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9719 LANTANA RD
LAKE WORTH FL
33467-6143
US

IV. Provider business mailing address

903 SW 27TH TER
BOYNTON BEACH FL
33435-7913
US

V. Phone/Fax

Practice location:
  • Phone: 646-417-2396
  • Fax:
Mailing address:
  • Phone: 646-417-2396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOS20017
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS021606
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: