=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578299038
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEANNIE BERNARD NURSE PRACTITIONER IN FAMILY HEALTH PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2022
-----------------------------------------------------
Last Update Date | 07/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 165 N VILLAGE AVE STE 200
-----------------------------------------------------
City | ROCKVILLE CENTRE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11570-3701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-502-1450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 939 SUNRISE HWY
-----------------------------------------------------
City | LYNBROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11563-2815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-502-1450
-----------------------------------------------------
Fax | 516-268-9812
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MRS. JEANNIE BERNARD
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 516-502-1450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------