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General NPI Number Information
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NPI Number | 1457340689
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Entity Type | Individual
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Provider Name | JEFFREY W BERNDTSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 11/07/2019
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Provider Practice Location Address
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Address Line | 3345 SOUTHWESTERN BLVD
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City | ORCHARD PARK
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State | NY
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Zip | 14127-1506
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Country | US
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Telephone | 716-656-4826
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Fax | 716-250-5981
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Provider Business Mailing Address
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Address Line | 6255 SHERIDAN DR STE 108
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-4825
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Country | US
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Telephone | 716-630-1219
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Fax | 716-817-1726
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 224211
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License Number State | NY
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