=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679664262
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRUCE BERNS D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 10/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2805 VETERANS HWY STE 8
-----------------------------------------------------
City | RONKONKOMA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11779-7680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-238-6799
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2805 VETERANS MEMORIAL HWY STE 8
-----------------------------------------------------
City | RONKONKOMA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11779-7680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-667-6117
-----------------------------------------------------
Fax | 631-667-6118
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 007206
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------