MEDICARE: PAUL B BERNSTEIN DPM PC

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	213EP1101X	Primary Podiatric Medicine Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P494692	OTHER	NY	OXFORD
2	0056997	OTHER	NY	GHI
3	P3890	OTHER	NY	EMPIRE BLUE CROSS

General Provider Information

NPI Number	:	1386731859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL B BERNSTEIN DPM PC

Provider Business Mailing Address
First Line	:	4200 SUNRISE HWY
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-5303
Country	:	US
Telephone Number	:	516-795-9030
Fax Number	:	516-513-1605

Provider Business Practice Location Address
First Line	:	4200 SUNRISE HWY
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-5303
Country	:	US
Telephone Number	:	516-795-9030
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PAUL BARRY BERNSTEIN
Credential	:	DPM
Telephone Number	:	516-795-9030

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	05/30/2008

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