Provider Demographics
NPI:1851366934
Name:SARA J BERNSTEIN MD LC
Entity Type:Organization
Organization Name:SARA J BERNSTEIN MD LC
Other - Org Name:SARA J BERNSTEIN MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-784-1933
Mailing Address - Street 1:11924 W FOREST HILL BLVD
Mailing Address - Street 2:SUITE 22-313
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6256
Mailing Address - Country:US
Mailing Address - Phone:561-784-1933
Mailing Address - Fax:561-784-5109
Practice Address - Street 1:10131 W FOREST HILL BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6156
Practice Address - Country:US
Practice Address - Phone:561-784-1933
Practice Address - Fax:561-784-5109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 79627207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20-1124411OtherDIMENSION HEALTH
FL20-1124411OtherGREAT WEST
FL20-1124411OtherPRIVATE HEALTHCARE SYSTEM
FL264231000Medicaid
FL298473OtherAVMED
FL7531723OtherCIGNA
FL51338OtherBLUE CROSS / BLUE SHIELD
FL45664OtherNEIGHBORHOOD HEALTH
FL20-1124411OtherUNITED
FL7872461OtherAETNA
FL20-1124411OtherBEECH STREET
FL20-1124411OtherONE-SOURCE
FL20-1124411OtherUNITED
FL7872461OtherAETNA