Provider Demographics
NPI:1790844025
Name:MARTIN E BERNSTEIN PC
Entity Type:Organization
Organization Name:MARTIN E BERNSTEIN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:303-989-1520
Mailing Address - Street 1:777 S WADSWORTH BLVD
Mailing Address - Street 2:BLDG 2 102
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-4300
Mailing Address - Country:US
Mailing Address - Phone:303-989-1520
Mailing Address - Fax:303-989-1520
Practice Address - Street 1:777 S WADSWORTH BLVD
Practice Address - Street 2:BLDG 2 102
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-4300
Practice Address - Country:US
Practice Address - Phone:303-989-1520
Practice Address - Fax:303-989-1520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO456103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90146Medicare PIN