=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427217934
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. AMANDA JILL BERNSTEIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2008
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2174 HEWLETT AVE STE 211
-----------------------------------------------------
City | MERRICK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11566-3620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-226-0374
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3317 BERTHA DR
-----------------------------------------------------
City | BALDWIN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11510-5006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-546-6818
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 019134-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------