Provider Demographics
NPI:1679664262
Name:BERNS, BRUCE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:BERNS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 VETERANS MEMORIAL HWY
Mailing Address - Street 2:STE 8
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7680
Mailing Address - Country:US
Mailing Address - Phone:631-667-6117
Mailing Address - Fax:631-667-6118
Practice Address - Street 1:2805 VETERANS HWY
Practice Address - Street 2:STE 8
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7680
Practice Address - Country:US
Practice Address - Phone:516-238-6799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX56331Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
NYU43585Medicare UPIN