=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629008271
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IRA BERNSTEIN DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2006
-----------------------------------------------------
Last Update Date | 01/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 S MAIN ST SUITE 3
-----------------------------------------------------
City | NEW CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10956-3002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-362-8400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 FIREMENS MEMORIAL DRIVE SUITE 115
-----------------------------------------------------
City | POMONA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-362-8400
-----------------------------------------------------
Fax | 845-362-8474
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 0N005869
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------