MEDICARE: MS. PETRA BERNARD MS.ED.

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	222Q00000X	Developmental Therapist	19048	NY

General Provider Information

NPI Number	:	1174814420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PETRA BERNARD MS.ED.

Provider Business Mailing Address
First Line	:	303 E 83RD ST
Second Line	:	26G
City	:	NEW YORK
State	:	NY
Zip	:	10028-4318
Country	:	US
Telephone Number	:	917-495-7129
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 E 83RD ST
Second Line	:	26G
City	:	NEW YORK
State	:	NY
Zip	:	10028-4318
Country	:	US
Telephone Number	:	917-495-7129
Fax Number	:

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

Provider Enumeration Date	:	04/20/2011
Last Update Date	:	04/20/2011

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