Provider Demographics
NPI:1063499507
Name:BERNSHTEYN, ALLA (MD)
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:BERNSHTEYN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 MASONIC AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-3095
Mailing Address - Country:US
Mailing Address - Phone:203-265-0355
Mailing Address - Fax:203-265-7413
Practice Address - Street 1:67 MASONIC AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-3095
Practice Address - Country:US
Practice Address - Phone:203-265-0355
Practice Address - Fax:203-265-7413
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001390450Medicaid
CT001390450Medicaid
H26586Medicare UPIN