Provider Demographics
NPI:1205018660
Name:BERNHARD HEERSINK MD PC
Entity Type:Organization
Organization Name:BERNHARD HEERSINK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:BERNHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HEERSINK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-462-8751
Mailing Address - Street 1:21 HIGHLAND AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950
Mailing Address - Country:US
Mailing Address - Phone:978-462-8751
Mailing Address - Fax:978-462-8920
Practice Address - Street 1:21 HIGHLAND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950
Practice Address - Country:US
Practice Address - Phone:978-462-8751
Practice Address - Fax:978-462-8920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37852207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M13052PCOtherPC#
M13052PCOtherPC#