=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942493648
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALVATORE BERNARDO, JR., M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2007
-----------------------------------------------------
Last Update Date | 08/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4255 US HIGHWAY 9 SUITE B
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-8305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-683-9897
-----------------------------------------------------
Fax | 732-683-9674
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6069
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-6069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-683-9897
-----------------------------------------------------
Fax | 732-683-9674
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SALVATORE BERNARDO JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 732-683-9897
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 25MA06069400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------