Provider Demographics
NPI:1497853808
Name:BERNS, HOLLY (MD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:
Last Name:BERNS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 SCHOOL ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2547
Mailing Address - Country:US
Mailing Address - Phone:516-674-0404
Mailing Address - Fax:
Practice Address - Street 1:58 SCHOOL ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2547
Practice Address - Country:US
Practice Address - Phone:516-674-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136754207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY30B701Medicare PIN
NYF94210Medicare UPIN