Provider Demographics
NPI:1932279395
Name:OSEROFF, BERNARD J (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:J
Last Name:OSEROFF
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 1:3170 WEST STREET
Mailing Address - Street 2:SUITE 275
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424
Mailing Address - Country:US
Mailing Address - Phone:585-394-0700
Mailing Address - Fax:585-394-5051
Practice Address - Street 1:3170 WEST ST
Practice Address - Street 2:SUITE 275
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1712
Practice Address - Country:US
Practice Address - Phone:585-394-0700
Practice Address - Fax:585-394-5051
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073717-1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB71932Medicare UPIN
NYRA4669Medicare ID - Type UnspecifiedMEDICARE