Provider Demographics
NPI:1093074965
Name:JONATHAN BERNSTEIN, M.D., LTD.
Entity Type:Organization
Organization Name:JONATHAN BERNSTEIN, M.D., LTD.
Other - Org Name:CHILDREN'S SPECIALTY CENTER OF NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-732-0232
Mailing Address - Street 1:3121 S. MARYLAND PARKWAY, SUITE 302
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2302
Mailing Address - Country:US
Mailing Address - Phone:702-732-1493
Mailing Address - Fax:702-732-1080
Practice Address - Street 1:540 W. PLUMB LANE, SUITE 200
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3683
Practice Address - Country:US
Practice Address - Phone:775-657-8981
Practice Address - Fax:775-657-8317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12808207SG0205X
NV83532080P0207X
NV134512080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Multi-Specialty
No207SG0205XAllopathic & Osteopathic PhysiciansMedical GeneticsPh.D. Medical GeneticsGroup - Multi-Specialty
No2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric RheumatologyGroup - Multi-Specialty