Provider Demographics
NPI:1093791212
Name:BERNSTEIN, JAY (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
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 1:6670 GLEN ACRES DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237
Mailing Address - Country:US
Mailing Address - Phone:513-600-5473
Mailing Address - Fax:
Practice Address - Street 1:100 DAWN LN
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-9138
Practice Address - Country:US
Practice Address - Phone:740-947-2186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHBE4044736207P00000X
OH35076065207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00105470OtherMEDICARE RAIL ROAD
OH000000317056OtherANTHEM/BCBS
OH000000558581OtherANTHEM BCBS PIKE
OH2121420Medicaid
OHP00608186Medicare PIN
OH4044738Medicare PIN
OH000000317056OtherANTHEM/BCBS
OHG47015Medicare UPIN
OH4257934Medicare PIN
OHP00105470OtherMEDICARE RAIL ROAD