Provider Demographics
NPI:1649526690
Name:BERNSTEIN, PATRICIA (NPP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2230
Mailing Address - Country:US
Mailing Address - Phone:631-981-8300
Mailing Address - Fax:
Practice Address - Street 1:2780 MIDDLE COUNTRY RD STE 306
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-2126
Practice Address - Country:US
Practice Address - Phone:631-981-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401505363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health