Provider Demographics
NPI:1255152310
Name:BERNSTEIN, ALEXANDER KEELEY
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:KEELEY
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E MORELAND RD STE A
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-4109
Mailing Address - Country:US
Mailing Address - Phone:215-784-9187
Mailing Address - Fax:
Practice Address - Street 1:101 E MORELAND RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-4109
Practice Address - Country:US
Practice Address - Phone:215-784-9187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03878261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech