Healthcare Provider Details

I. General information

NPI: 1699167510
Provider Name (Legal Business Name): JAKE BERNATH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282D CEDAR BRIDGE AVE
LAKEWOOD NJ
08701-4265
US

IV. Provider business mailing address

282D CEDAR BRIDGE AVE
LAKEWOOD NJ
08701-4265
US

V. Phone/Fax

Practice location:
  • Phone: 732-200-1282
  • Fax:
Mailing address:
  • Phone: 732-200-1282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: