Provider Demographics
NPI:1578959458
Name:BERNARD, KATHLEEN LILE (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LILE
Last Name:BERNARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1824 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-3832
Mailing Address - Country:US
Mailing Address - Phone:212-241-4300
Mailing Address - Fax:
Practice Address - Street 1:3360 ROUTE 343
Practice Address - Street 2:
Practice Address - City:AMENIA
Practice Address - State:NY
Practice Address - Zip Code:12501-5619
Practice Address - Country:US
Practice Address - Phone:845-838-7038
Practice Address - Fax:845-373-6028
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY291422207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY291422OtherNY LICENSE