Healthcare Provider Details

I. General information

NPI: 1568904340
Provider Name (Legal Business Name): CANDACE BERNITT MED, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CAMPUS RD
ANNANDALE ON HUDSON NY
12504-9800
US

IV. Provider business mailing address

633 MILL RD
RHINEBECK NY
12572-2549
US

V. Phone/Fax

Practice location:
  • Phone: 845-417-7520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number003232
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: