Healthcare Provider Details

I. General information

NPI: 1093713638
Provider Name (Legal Business Name): JONATHAN A BERNSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4665 E GALBRAITH RD FL 2
CINCINNATI OH
45236-2783
US

IV. Provider business mailing address

4665 E GALBRAITH RD FL 2
CINCINNATI OH
45236-2783
US

V. Phone/Fax

Practice location:
  • Phone: 513-931-0775
  • Fax: 513-931-0779
Mailing address:
  • Phone: 513-931-0775
  • Fax: 513-931-0798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number35 053762
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35 053762
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: