Provider Demographics
NPI:1447251095
Name:BERNSTEIN, MITCHELL (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W 59TH ST
Mailing Address - Street 2:9A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1104
Mailing Address - Country:US
Mailing Address - Phone:212-523-8417
Mailing Address - Fax:212-523-8186
Practice Address - Street 1:425 W 59TH ST
Practice Address - Street 2:9A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1104
Practice Address - Country:US
Practice Address - Phone:212-523-8417
Practice Address - Fax:212-523-8186
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199737208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01591831Medicaid
NY48L771Medicare PIN
NY01591831Medicaid