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General NPI Number Information
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NPI Number | 1578615290
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Entity Type | Organization
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Legal Business Name | IRA BERNSTEIN
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 350 S MAIN ST
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City | NEW CITY
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State | NY
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Zip | 10956-3002
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Country | US
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Telephone | 800-750-8616
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Fax |
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Provider Business Mailing Address
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Address Line | 26 FIREMENS MEM DRIVE SUITE 115
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City | POMONA
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State | NY
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Zip | 10970
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Country | US
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Telephone | 845-362-8400
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Fax | 845-362-8474
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Authorized Official
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Title or Position | OWNER
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Name | IRA BERNSTEIN
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Credential | DPM
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Telephone | 845-362-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N005869
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License Number State | NY
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