Provider Demographics
NPI:1710909502
Name:BERNSTEIN, MARK L (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 ROUTE 347
Mailing Address - Street 2:BLDG 8D
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790
Mailing Address - Country:US
Mailing Address - Phone:631-689-7780
Mailing Address - Fax:631-689-5669
Practice Address - Street 1:2500 ROUTE 347
Practice Address - Street 2:BLDG 8D
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790
Practice Address - Country:US
Practice Address - Phone:631-689-7780
Practice Address - Fax:631-689-5669
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1419400207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP571OtherOXFORD HEALTHCARE
4288912OtherAETNA
NY00710467Medicaid
C09154Medicare UPIN
CP571OtherOXFORD HEALTHCARE