MEDICARE: KUNSOOK S. BERNSTEIN PHD, NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	400473-1	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G300080043	OTHER	NY	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124016258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KUNSOOK S. BERNSTEIN PHD, NP

Provider Business Mailing Address
First Line	:	3321 HARBOR POINT RD
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-5164
Country	:	US
Telephone Number	:	516-456-7512
Fax Number	:

Provider Business Practice Location Address
First Line	:	3321 HARBOR POINT RD
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-5164
Country	:	US
Telephone Number	:	516-456-7512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	11/28/2012

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