Provider Demographics
NPI:1205917812
Name:BERNSTEIN, STACY A (MD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:A
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:ARLYN
Other - Last Name:LEVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:592B SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1026
Mailing Address - Country:US
Mailing Address - Phone:908-233-8860
Mailing Address - Fax:908-654-7728
Practice Address - Street 1:592B SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1026
Practice Address - Country:US
Practice Address - Phone:908-233-8860
Practice Address - Fax:908-654-7728
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08431700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315016328OtherSTATE LICENSE