Provider Demographics
NPI:1083698989
Name:BERNSTEIN, ANDREW D (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:D
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:ANDY
Other - Middle Name:
Other - Last Name:BERNSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:106 VALLEY ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2886
Mailing Address - Country:US
Mailing Address - Phone:973-378-8035
Mailing Address - Fax:973-731-7116
Practice Address - Street 1:106 VALLEY ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2886
Practice Address - Country:US
Practice Address - Phone:973-378-8035
Practice Address - Fax:973-731-7116
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3114103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ543862Medicaid
NJ543862 U-18Medicare UPIN