Provider Demographics
NPI:1023031135
Name:LAITMAN, BERNARD I (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:I
Last Name:LAITMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SQUADRON BLVD
Mailing Address - Street 2:STE 290
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956
Mailing Address - Country:US
Mailing Address - Phone:845-634-9400
Mailing Address - Fax:845-634-0547
Practice Address - Street 1:20 SQUADRON BLVD
Practice Address - Street 2:STE 290
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956
Practice Address - Country:US
Practice Address - Phone:845-634-9400
Practice Address - Fax:845-634-0547
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00687985Medicaid
WELL161Medicare ID - Type Unspecified
B17137Medicare UPIN