Provider Demographics
NPI:1184841041
Name:BERNARD SOSNER MD, A MEDICAL CORP
Entity Type:Organization
Organization Name:BERNARD SOSNER MD, A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SOSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-788-8400
Mailing Address - Street 1:16055 VENTURA BLVD
Mailing Address - Street 2:SUITE NUMBER 926
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2601
Mailing Address - Country:US
Mailing Address - Phone:818-788-8400
Mailing Address - Fax:818-788-8434
Practice Address - Street 1:16055 VENTURA BLVD
Practice Address - Street 2:SUITE NUMBER 926
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2601
Practice Address - Country:US
Practice Address - Phone:818-788-8400
Practice Address - Fax:818-788-8434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA18617261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA18617Medicare PIN