Provider Demographics
NPI:1417949389
Name:BERNARD, PETER JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JAY
Last Name:BERNARD
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 1:55 E 87TH ST
Mailing Address - Street 2:SUITE 1AK
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1043
Mailing Address - Country:US
Mailing Address - Phone:212-289-1731
Mailing Address - Fax:212-427-5286
Practice Address - Street 1:55 E 87TH ST
Practice Address - Street 2:SUITE 1AK
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1043
Practice Address - Country:US
Practice Address - Phone:212-289-1731
Practice Address - Fax:212-427-5286
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155305207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY88D611Medicare ID - Type Unspecified
NYA64644Medicare UPIN