Provider Demographics
NPI:1649450610
Name:BERNSTONE, MARTIN GERALD (DPM)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:GERALD
Last Name:BERNSTONE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15110 KITTRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4526
Mailing Address - Country:US
Mailing Address - Phone:818-785-0444
Mailing Address - Fax:818-785-0444
Practice Address - Street 1:15110 KITTRIDGE ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4526
Practice Address - Country:US
Practice Address - Phone:818-785-0444
Practice Address - Fax:818-785-0444
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1690213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E16900Medicaid
E1690Medicare PIN
T19130Medicare UPIN