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General NPI Number Information
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NPI Number | 1265843924
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Entity Type | Individual
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Provider Name | TEDDY BERNARD
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Gender | Male
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 130 FIELDMERE ST
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City | ELMONT
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State | NY
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Zip | 11003-2007
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Country | US
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Telephone | 407-346-8577
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 365
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City | WEST HEMPSTEAD
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State | NY
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Zip | 11552-0365
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Country | US
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Telephone | 407-346-8577
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 008294-1
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License Number State | NY
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