Healthcare Provider Details

I. General information

NPI: 1417696154
Provider Name (Legal Business Name): ELIJAH BERNSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LATTIMORE RD
ROCHESTER NY
14620-4159
US

IV. Provider business mailing address

125 LATTIMORE RD
ROCHESTER NY
14620-4159
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2691
  • Fax:
Mailing address:
  • Phone: 585-275-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: