Provider Demographics
NPI:1851492904
Name:BERNHARDT, STEPHEN R (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:BERNHARDT
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 1:340 HOWELLS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-5309
Mailing Address - Country:US
Mailing Address - Phone:631-666-2808
Mailing Address - Fax:631-666-3097
Practice Address - Street 1:340 HOWELLS RD
Practice Address - Street 2:SUITE A
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5309
Practice Address - Country:US
Practice Address - Phone:631-666-2808
Practice Address - Fax:631-666-3097
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204772207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01856422Medicaid
NY01856422Medicaid
37N121Medicare PIN