Provider Demographics
NPI:1902818339
Name:BERNSTEIN, MARIA REBBECA (ANP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:REBBECA
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:POB 1012
Mailing Address - Street 2:PORT WASHINGTON
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1353
Mailing Address - Country:US
Mailing Address - Phone:516-629-2469
Mailing Address - Fax:516-629-2027
Practice Address - Street 1:100 PORT WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1353
Practice Address - Country:US
Practice Address - Phone:516-629-2469
Practice Address - Fax:516-629-2027
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301593363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02708556Medicaid
NYQ61352Medicare UPIN
NY1471G1Medicare ID - Type Unspecified