Provider Demographics
NPI:1083619993
Name:BERNSTEIN, PHILIP E (DPM)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:E
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 N WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3218
Mailing Address - Country:US
Mailing Address - Phone:610-688-1682
Mailing Address - Fax:610-688-4708
Practice Address - Street 1:308 N WAYNE AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3218
Practice Address - Country:US
Practice Address - Phone:610-688-1682
Practice Address - Fax:610-688-4708
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002551L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000937233Medicaid
PA088924Other088924
PAT30467Medicare UPIN
PA443786E6KMedicare PIN
PA000937233Medicaid