Provider Demographics
NPI:1760714646
Name:BERNSTEIN, MATTHEW IAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:IAN
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 STRAWBERRY HILL AVE APT 52
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2580
Mailing Address - Country:US
Mailing Address - Phone:954-295-0475
Mailing Address - Fax:
Practice Address - Street 1:3619 PROVOST AVE FL 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-6145
Practice Address - Country:US
Practice Address - Phone:347-719-4330
Practice Address - Fax:855-326-6768
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03496100183500000X
FLPS46126183500000X
NY054287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist