Provider Demographics
NPI:1598735599
Name:BORNSTEIN, BARRY YVES (PA)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:YVES
Last Name:BORNSTEIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-737-1880
Mailing Address - Fax:702-737-5988
Practice Address - Street 1:5820 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3002
Practice Address - Country:US
Practice Address - Phone:702-737-1880
Practice Address - Fax:702-737-5988
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA920363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCI7026OtherGROUP RAILROAD MEDICARE
NVP00401651OtherRAILROAD MEDICARE
NV100507665Medicaid
Q59036Medicare UPIN
NV101743Medicare PIN
NV100507665Medicaid