Provider Demographics
NPI:1497817696
Name:ALTER, BERNARD RENE (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:RENE
Last Name:ALTER
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 1:127 WOLF AVENUE
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1523
Mailing Address - Country:US
Mailing Address - Phone:516-596-0353
Mailing Address - Fax:516-596-3923
Practice Address - Street 1:532 NEPTUNE AVENUE
Practice Address - Street 2:SUITE #209
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4008
Practice Address - Country:US
Practice Address - Phone:718-449-8860
Practice Address - Fax:718-372-4233
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139812208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00843494Medicaid
B10747Medicare UPIN
NY00843494Medicaid