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General NPI Number Information
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NPI Number | 1134299365
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Entity Type | Organization
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Legal Business Name | BERNARD S POTTER MD PC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/31/2007
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Provider Practice Location Address
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Address Line | 410 WOLF HILL ROAD
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City | DIX HILLS
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State | NY
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Zip | 11746-5695
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Country | US
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Telephone | 631-271-8850
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Fax | 631-271-8853
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Provider Business Mailing Address
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Address Line | 410 WOLF HILL ROAD
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City | DIX HILLS
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State | NY
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Zip | 11746-5695
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Country | US
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Telephone | 631-271-8850
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Fax | 631-271-8853
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BERNARD S POTTER
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Credential | MD
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Telephone | 631-271-8850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 96606
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License Number State | NY
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