Provider Demographics
NPI:1942493648
Name:SALVATORE BERNARDO, JR., M.D., P.A.
Entity Type:Organization
Organization Name:SALVATORE BERNARDO, JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARDO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:732-683-9897
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-6069
Mailing Address - Country:US
Mailing Address - Phone:732-683-9897
Mailing Address - Fax:732-683-9674
Practice Address - Street 1:4255 US HIGHWAY 9
Practice Address - Street 2:SUITE B
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8305
Practice Address - Country:US
Practice Address - Phone:732-683-9897
Practice Address - Fax:732-683-9674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-26
Last Update Date:2007-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06069400261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7202008Medicaid
NJ873799Medicare PIN
NJ7202008Medicaid