Provider Demographics
NPI:1124016258
Name:BERNSTEIN, KUNSOOK S (PHD, NP)
Entity Type:Individual
Prefix:
First Name:KUNSOOK
Middle Name:S
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:PHD, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 HARBOR POINT RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-5164
Mailing Address - Country:US
Mailing Address - Phone:516-456-7512
Mailing Address - Fax:
Practice Address - Street 1:3321 HARBOR POINT RD
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-5164
Practice Address - Country:US
Practice Address - Phone:516-456-7512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400473-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG300080043OtherMEDICARE ID
NY02061347Medicaid
NY02061347Medicaid