1710057625 NPI number — MARIE G BERNARD MD

Table of content: MARIE G BERNARD MD (NPI 1710057625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710057625 NPI number — MARIE G BERNARD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERNARD
Provider First Name:
MARIE
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1710057625
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 ROUTE 31
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
FLEMINGTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08822-5795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-284-9880
Provider Business Mailing Address Fax Number:
908-782-4316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 RT 31
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
FLEMINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08822-5772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-284-9880
Provider Business Practice Location Address Fax Number:
908-782-4316
Provider Enumeration Date:
11/08/2006

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: 207Q00000X , with the licence number:  25MA05548300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: MA55483 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080123744 . This is a "RAILROAD MEDICARE ID#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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