1598806069 NPI number — DR. MICHAEL PAUL BERNSTEIN DPM

Table of content: DR. MICHAEL PAUL BERNSTEIN DPM (NPI 1598806069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598806069 NPI number — DR. MICHAEL PAUL BERNSTEIN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERNSTEIN
Provider First Name:
MICHAEL
Provider Middle Name:
PAUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1598806069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 ROUTES 6 AND 209
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18337-9490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-296-9296
Provider Business Mailing Address Fax Number:
570-296-2158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 ROUTES 6 AND 209
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18337-7615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-296-9296
Provider Business Practice Location Address Fax Number:
570-296-2158
Provider Enumeration Date:
02/09/2007

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: 213ES0103X , with the licence number:  SC003820L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 749584 . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 472147 . This is a "MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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