Provider Demographics
NPI:1952708836
Name:BERNADSKY, BORIS BENJAMIN (LMT LAC)
Entity Type:Individual
Prefix:MR
First Name:BORIS
Middle Name:BENJAMIN
Last Name:BERNADSKY
Suffix:
Gender:M
Credentials:LMT LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1368 BAY RIDGE AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-6116
Mailing Address - Country:US
Mailing Address - Phone:732-331-0925
Mailing Address - Fax:
Practice Address - Street 1:40 EXCHANGE PL
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-2701
Practice Address - Country:US
Practice Address - Phone:732-331-0925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27 027747225700000X
NY25 005638171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist