1831155936 NPI number — SHERRIE H BERNAT NP

Table of content: (NPI 1962413997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831155936 NPI number — SHERRIE H BERNAT NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERNAT
Provider First Name:
SHERRIE
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALIK
Provider Other First Name:
SHERRIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831155936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 CARTER ST
Provider Second Line Business Mailing Address:
ATTN KELLY STEELE
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14621-2604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-339-4793
Provider Business Mailing Address Fax Number:
585-336-4845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
899 MAIN ST
Provider Second Line Business Practice Location Address:
WILLIAM E MOSHER HEALTH CENTER
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14203-1109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-878-2700
Provider Business Practice Location Address Fax Number:
716-504-5544
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  420113 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 180047CK . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9513166 . This is a "IHA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000560341004 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040501003374 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10766768 . This is a "CAQH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8494418 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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