Healthcare Provider Details

I. General information

NPI: 1851380950
Provider Name (Legal Business Name): LARRY JAY BERNSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7235 112TH ST PR-5
FOREST HILLS NY
11375-5469
US

IV. Provider business mailing address

7050 173RD ST
FRESH MEADOWS NY
11365-3450
US

V. Phone/Fax

Practice location:
  • Phone: 718-544-6641
  • Fax: 718-544-6656
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number143184
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: