1851366934 NPI number — SARA J BERNSTEIN MD LC

Table of content: (NPI 1851366934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851366934 NPI number — SARA J BERNSTEIN MD LC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SARA J BERNSTEIN MD LC
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:
SARA J BERNSTEIN MD PA
Provider Other Organization Name Type Code:
4
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:
1851366934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11924 W FOREST HILL BLVD
Provider Second Line Business Mailing Address:
SUITE 22-313
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33414-6256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-784-1933
Provider Business Mailing Address Fax Number:
561-784-5109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10131 W FOREST HILL BLVD
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33414-6156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-784-1933
Provider Business Practice Location Address Fax Number:
561-784-5109
Provider Enumeration Date:
02/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERNSTEIN
Authorized Official First Name:
SARA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
561-784-1933

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  ME 79627 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20-1124411 . This is a "DIMENSION HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 20-1124411 . This is a "GREAT WEST" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 20-1124411 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 264231000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 298473 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7531723 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 51338 . This is a "BLUE CROSS / BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 45664 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 20-1124411 . This is a "UNITED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7872461 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 20-1124411 . This is a "BEECH STREET" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 20-1124411 . This is a "ONE-SOURCE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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