Healthcare Provider Details

I. General information

NPI: 1710057625
Provider Name (Legal Business Name): MARIE G BERNARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 RT 31 SUITE 111
FLEMINGTON NJ
08822-5772
US

IV. Provider business mailing address

111 ROUTE 31 SUITE 111
FLEMINGTON NJ
08822-5795
US

V. Phone/Fax

Practice location:
  • Phone: 908-284-9880
  • Fax: 908-782-4316
Mailing address:
  • Phone: 908-284-9880
  • Fax: 908-782-4316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA05548300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMA55483
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: