MEDICARE: MARTIN E BERNSTEIN 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	103T00000X	Psychologist	456	CO

General Provider Information

NPI Number	:	1790844025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTIN E BERNSTEIN PC

Provider Business Mailing Address
First Line	:	777 S WADSWORTH BLVD
Second Line	:	BLDG 2 102
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-4300
Country	:	US
Telephone Number	:	303-989-1520
Fax Number	:	303-989-1520

Provider Business Practice Location Address
First Line	:	777 S WADSWORTH BLVD
Second Line	:	BLDG 2 102
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-4300
Country	:	US
Telephone Number	:	303-989-1520
Fax Number	:	303-989-1520

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARTIN BERNSTEIN
Credential	:	ED.D.
Telephone Number	:	303-989-1520

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	09/07/2007

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