Provider Demographics
NPI:1982959706
Name:MICHAEL BERNSTEIN MDPC
Entity Type:Organization
Organization Name:MICHAEL BERNSTEIN MDPC
Other - Org Name:UNIVERSAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-641-4382
Mailing Address - Street 1:275 CENTRAL AVENUE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559
Mailing Address - Country:US
Mailing Address - Phone:718-641-4382
Mailing Address - Fax:
Practice Address - Street 1:275 CENTRAL AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1581
Practice Address - Country:US
Practice Address - Phone:718-641-4382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001763922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02726621Medicaid
NY02726621Medicaid