MEDICARE: MRS. SARA JESSICA BERNSTEIN MS CCC-SLP

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	235Z00000X	Speech-Language Pathologist		NY

General Provider Information

NPI Number	:	1891016093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA JESSICA BERNSTEIN MS CCC-SLP

Provider Business Mailing Address
First Line	:	3515 HENRY HUDSON PKWY W
Second Line	:	APT. 3D
City	:	BRONX
State	:	NY
Zip	:	10463-1326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3515 HENRY HUDSON PKWY W
Second Line	:	APT. 3D
City	:	BRONX
State	:	NY
Zip	:	10463-1326
Country	:	US
Telephone Number	:	347-964-6563
Fax Number	:

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

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	06/22/2010

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