1578883971 NPI number — LEONARD S BERNSTEIN M D INC

Table of content: (NPI 1578883971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578883971 NPI number — LEONARD S BERNSTEIN M D INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEONARD S BERNSTEIN M D INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578883971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 WASHINGTON ST
Provider Second Line Business Mailing Address:
#508
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92103-2231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-299-2570
Provider Business Mailing Address Fax Number:
619-819-7258

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 WASHINGTON ST
Provider Second Line Business Practice Location Address:
#508
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-299-2570
Provider Business Practice Location Address Fax Number:
619-819-7258
Provider Enumeration Date:
06/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BERNSTEIN
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
619-299-2570

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G16410 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DG193A . This is a "PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G16410 . This is a "LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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