Healthcare Provider Details

I. General information

NPI: 1932936259
Provider Name (Legal Business Name): CARLY BERNSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 MANETTO HILL RD STE 8
PLAINVIEW NY
11803-1318
US

IV. Provider business mailing address

169 GARFIELD AVE
MINEOLA NY
11501-2506
US

V. Phone/Fax

Practice location:
  • Phone: 516-346-5757
  • Fax:
Mailing address:
  • Phone: 484-201-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number032449-01
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: