Healthcare Provider Details

I. General information

NPI: 1982959706
Provider Name (Legal Business Name): MICHAEL BERNSTEIN MDPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 CENTRAL AVE SUITE 2
LAWRENCE NY
11559-1581
US

IV. Provider business mailing address

275 CENTRAL AVENUE SUITE 2
LAWRENCE NY
11559
US

V. Phone/Fax

Practice location:
  • Phone: 718-641-4382
  • Fax:
Mailing address:
  • Phone: 718-641-4382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number00176392
License Number StateNY

VIII. Authorized Official

Name: MR. MICHAEL BERNSTEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 718-641-4382