Provider Demographics
NPI:1629276977
Name:ANDREW D. BERNSTEIN, PHD
Entity Type:Organization
Organization Name:ANDREW D. BERNSTEIN, PHD
Other - Org Name:ANDY BERNSTEIN, PHD
Other - Org Type:Other Name
Authorized Official - Title/Position:CONSULTING PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-378-8035
Mailing Address - Street 1:106 VALLEY ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2886
Mailing Address - Country:US
Mailing Address - Phone:973-378-8035
Mailing Address - Fax:973-731-7116
Practice Address - Street 1:106 VALLEY ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2886
Practice Address - Country:US
Practice Address - Phone:973-378-8035
Practice Address - Fax:973-731-7116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-09
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3114103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJES549OtherOXFORD HEALTH INSURANCE
NJ098375Medicare PIN