Provider Demographics
NPI:1093750127
Name:BERNARD, MARIE ANTOINETTE (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:ANTOINETTE
Last Name:BERNARD
Suffix:
Gender:F
Credentials:MD MPH
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:125 WORTH ST
Mailing Address - Street 2:RM 901 BOY 22 NYCDOHMH DIVISION OF DISEASE CONTROL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4006
Mailing Address - Country:US
Mailing Address - Phone:212-442-8468
Mailing Address - Fax:212-442-8452
Practice Address - Street 1:34-33 JUNCTION BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-476-7635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY18818012083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1881801OtherNY STATE LIC NUMBER