Provider Demographics
NPI:1568512192
Name:BERNSTEIN, MICHAEL O (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:O
Last Name:BERNSTEIN
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 1:350 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6001
Mailing Address - Country:US
Mailing Address - Phone:718-780-1563
Mailing Address - Fax:718-780-4703
Practice Address - Street 1:350 HENRY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6001
Practice Address - Country:US
Practice Address - Phone:718-780-1563
Practice Address - Fax:718-780-4703
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162161-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01082402Medicaid
NY01082402Medicaid
NY27E261Medicare ID - Type Unspecified