Healthcare Provider Details

I. General information

NPI: 1538416185
Provider Name (Legal Business Name): MARY BERNARDO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 5TH AVE FL 11
NEW YORK NY
10001-8017
US

IV. Provider business mailing address

103 OAKTREE PL
LEONIA NJ
07605-1919
US

V. Phone/Fax

Practice location:
  • Phone: 201-277-4646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00386800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00386800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF337475-01
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF406984-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: