Provider Demographics
NPI:1881830362
Name:BERNHARDT, DERIK ADAM (MOTR/L)
Entity Type:Individual
Prefix:MR
First Name:DERIK
Middle Name:ADAM
Last Name:BERNHARDT
Suffix:
Gender:M
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 2ND AVE
Mailing Address - Street 2:APT 3E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4618
Mailing Address - Country:US
Mailing Address - Phone:212-920-6077
Mailing Address - Fax:
Practice Address - Street 1:391 2ND AVE
Practice Address - Street 2:APT 3E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4618
Practice Address - Country:US
Practice Address - Phone:212-920-6077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013385-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist