Provider Demographics
NPI:1598844466
Name:BERNSTEIN, DIANE L (PT)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:L
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 BRANDON DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3720
Mailing Address - Country:US
Mailing Address - Phone:914-241-2443
Mailing Address - Fax:914-241-2443
Practice Address - Street 1:58 BRANDON DR
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3720
Practice Address - Country:US
Practice Address - Phone:914-241-2443
Practice Address - Fax:914-241-2443
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003841-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWS721OtherOXFORD HEALTH PLANS
NYQ53361Medicare ID - Type Unspecified