Provider Demographics
NPI:1790028603
Name:HAN, BERNADINE H (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:BERNADINE
Middle Name:H
Last Name:HAN
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:45 PLAZA ST W STE 1A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3967
Mailing Address - Country:US
Mailing Address - Phone:917-757-2729
Mailing Address - Fax:517-330-3083
Practice Address - Street 1:45 PLAZA ST W STE 1A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3967
Practice Address - Country:US
Practice Address - Phone:917-757-2729
Practice Address - Fax:517-330-3083
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2755352084P0802X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04622464Medicaid
NYA400167218Medicare PIN