Provider Demographics
NPI:1508039736
Name:BERNARDINO, LOURDES G (MD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:G
Last Name:BERNARDINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LOURDES
Other - Middle Name:GALAS
Other - Last Name:PINGOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5 LEE CT
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1426
Mailing Address - Country:US
Mailing Address - Phone:516-829-8240
Mailing Address - Fax:
Practice Address - Street 1:28 WELLS AVE
Practice Address - Street 2:AUREON LABORATORIES, INC.
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-2788
Practice Address - Country:US
Practice Address - Phone:914-377-4089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244786-1207ZP0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology