Provider Demographics
NPI:1073540613
Name:BERNSTEIN, MICHAEL H (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:BERNSTEIN
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 1:220 HAMBURG TPKE
Mailing Address - Street 2:STE 2
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2151
Mailing Address - Country:US
Mailing Address - Phone:973-790-8094
Mailing Address - Fax:973-790-8095
Practice Address - Street 1:220 HAMBURG TPKE STE 2
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-790-8094
Practice Address - Fax:973-790-8095
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02536600208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2817403Medicaid
NJ107082Medicare PIN
NJ2817403Medicaid