Provider Demographics
NPI:1417195843
Name:BERNSTEIN, EVAN ANDREW (MS)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:ANDREW
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 NEW DORP PLZ S STE 105
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2902
Mailing Address - Country:US
Mailing Address - Phone:718-980-7700
Mailing Address - Fax:718-980-7701
Practice Address - Street 1:88 NEW DORP PLZ S STE 105
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2902
Practice Address - Country:US
Practice Address - Phone:718-980-7700
Practice Address - Fax:718-980-7701
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00075100231H00000X
NY002195-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist