Provider Demographics
NPI:1235454398
Name:BERNHARDT, IRWIN
Entity Type:Individual
Prefix:
First Name:IRWIN
Middle Name:
Last Name:BERNHARDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3274
Mailing Address - Country:US
Mailing Address - Phone:212-737-1280
Mailing Address - Fax:212-472-6970
Practice Address - Street 1:1065 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3274
Practice Address - Country:US
Practice Address - Phone:212-737-1280
Practice Address - Fax:212-472-6970
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183522419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist