Healthcare Provider Details

I. General information

NPI: 1023972544
Provider Name (Legal Business Name): BLAKE BERNSTEIN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 ISLIP AVE
ISLIP NY
11751-3210
US

IV. Provider business mailing address

159 ISLIP AVE
ISLIP NY
11751-3210
US

V. Phone/Fax

Practice location:
  • Phone: 631-775-0971
  • Fax: 631-475-0975
Mailing address:
  • Phone: 631-775-0971
  • Fax: 631-475-0975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number054690-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: