Provider Demographics
NPI:1932102688
Name:BERNSTEIN, PAUL BARRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BARRY
Last Name:BERNSTEIN
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 1:4200 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5303
Mailing Address - Country:US
Mailing Address - Phone:516-795-9030
Mailing Address - Fax:516-513-1605
Practice Address - Street 1:4200 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5303
Practice Address - Country:US
Practice Address - Phone:516-795-9030
Practice Address - Fax:516-513-1605
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003536213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP38902Medicare PIN
NYT31998Medicare UPIN
NY40082HMedicare PIN