Provider Demographics
NPI:1134299365
Name:BERNARD S POTTER MD PC
Entity Type:Organization
Organization Name:BERNARD S POTTER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-271-8850
Mailing Address - Street 1:410 WOLF HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5695
Mailing Address - Country:US
Mailing Address - Phone:631-271-8850
Mailing Address - Fax:631-271-8853
Practice Address - Street 1:410 WOLF HILL ROAD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5695
Practice Address - Country:US
Practice Address - Phone:631-271-8850
Practice Address - Fax:631-271-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY96606207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty