Healthcare Provider Details

I. General information

NPI: 1619939329
Provider Name (Legal Business Name): IRA BERNSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 KINDERKAMACK RD SUITE 300
RIVER EDGE NJ
07661-1939
US

IV. Provider business mailing address

130 KINDERKAMACK RD SUITE 300
RIVER EDGE NJ
07661-1939
US

V. Phone/Fax

Practice location:
  • Phone: 201-489-2727
  • Fax: 201-489-5040
Mailing address:
  • Phone: 201-489-2727
  • Fax: 201-489-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA02459100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: