Provider Demographics
NPI:1508847104
Name:BERNSTEIN, CHARLES G (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:G
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:229 BEACH 136TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1323
Mailing Address - Country:US
Mailing Address - Phone:718-980-5767
Mailing Address - Fax:718-980-5733
Practice Address - Street 1:1776 RICHMOND RD STE 3
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2581
Practice Address - Country:US
Practice Address - Phone:718-980-5767
Practice Address - Fax:718-980-5733
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY151111207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01015989Medicaid
C06690Medicare UPIN
NY01015989Medicaid