Provider Demographics
NPI:1629008271
Name:BERNSTEIN, IRA (DPM)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 FIREMENS MEMORIAL DRIVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970
Mailing Address - Country:US
Mailing Address - Phone:845-362-8400
Mailing Address - Fax:845-362-8474
Practice Address - Street 1:350 S MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3002
Practice Address - Country:US
Practice Address - Phone:845-362-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0N005869213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPH1611Medicare PIN
NYU99235Medicare UPIN
NY5068250001Medicare NSC