Provider Demographics
NPI:1972640761
Name:ROBERT BERNHOLC MD PC
Entity Type:Organization
Organization Name:ROBERT BERNHOLC MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:RAE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-648-4471
Mailing Address - Street 1:13 E GATE LN
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1645
Mailing Address - Country:US
Mailing Address - Phone:631-648-4471
Mailing Address - Fax:631-648-4478
Practice Address - Street 1:13 E GATE LN
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1645
Practice Address - Country:US
Practice Address - Phone:631-648-4471
Practice Address - Fax:631-648-4478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEH321Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NYDA9156Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP#