Provider Demographics
NPI:1407813579
Name:BERNSTEIN, GARY RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:RICHARD
Last Name:BERNSTEIN
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 1:3400 NESCONSET HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3327
Mailing Address - Country:US
Mailing Address - Phone:631-751-8711
Mailing Address - Fax:631-751-5971
Practice Address - Street 1:3400 NESCONSET HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3327
Practice Address - Country:US
Practice Address - Phone:631-751-8711
Practice Address - Fax:631-751-5971
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153723207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00951717Medicaid
NYA63738Medicare UPIN
NY00951717Medicaid