Provider Demographics
NPI:1205801131
Name:BERNSTEIN, MICHAEL L (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:BERNSTEIN
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 1:17 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-1703
Mailing Address - Country:US
Mailing Address - Phone:732-462-9622
Mailing Address - Fax:732-780-0014
Practice Address - Street 1:65 HIGHWAY #34
Practice Address - Street 2:SUITE 200
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722
Practice Address - Country:US
Practice Address - Phone:732-431-2620
Practice Address - Fax:732-780-0014
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03549200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1611208Medicaid
NJ7461402Medicaid
NJ005191Medicare ID - Type UnspecifiedMEDICARE GROUP
NJ158204LOFMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
NJ1611208Medicaid