Provider Demographics
NPI:1609066737
Name:BERNSTEIN, EUGENE A (LIC AC)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:A
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55A SAINT PAUL ST
Mailing Address - Street 2:APT. #2
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6564
Mailing Address - Country:US
Mailing Address - Phone:617-277-7865
Mailing Address - Fax:
Practice Address - Street 1:55A SAINT PAUL ST
Practice Address - Street 2:APT. #2
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6564
Practice Address - Country:US
Practice Address - Phone:617-277-7865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202814171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist