Provider Demographics
NPI:1326099532
Name:ISTRIA, BERNARD JEAN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:JEAN MARIE
Last Name:ISTRIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 49TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2422
Mailing Address - Country:US
Mailing Address - Phone:718-436-2888
Mailing Address - Fax:718-972-9211
Practice Address - Street 1:848 49TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2422
Practice Address - Country:US
Practice Address - Phone:718-436-2888
Practice Address - Fax:718-972-9211
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202021-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02126525Medicaid
NY02126525Medicaid
NY972371Medicare PIN
NYA27140Medicare UPIN