Provider Demographics
NPI:1851380950
Name:BERNSTEIN, LARRY JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JAY
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 173RD ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3450
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7235 112TH ST
Practice Address - Street 2:PR-5
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5469
Practice Address - Country:US
Practice Address - Phone:718-544-6641
Practice Address - Fax:718-544-6656
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143184207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00790836Medicaid
NY66138AMedicare PIN
NY00790836Medicaid
NY03602Medicare ID - Type UnspecifiedBRONX