Provider Demographics
NPI:1134413826
Name:MICHAEL P. BERNSTEIN, MD
Entity type:Organization
Organization Name:MICHAEL P. BERNSTEIN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-763-3243
Mailing Address - Street 1:146 HAZARD AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4571
Mailing Address - Country:US
Mailing Address - Phone:860-763-3243
Mailing Address - Fax:860-763-3244
Practice Address - Street 1:146 HAZARD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4571
Practice Address - Country:US
Practice Address - Phone:860-763-3243
Practice Address - Fax:860-763-3244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000396231H00000X, 332S00000X, 335E00000X, 332B00000X, 237600000X, 237700000X, 235500000X
CT027001207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001270016Medicaid
CT040000186Medicare PIN
CTC65040Medicare UPIN