Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 035143-1 | NY |
NPI | 1063435790 |
---|---|
Provider Name | Andrew Bernard |
First Address | Bay Shore, NY 11706-8413 |
Second Address | Bay Shore, NY 11706-8413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
035143-1 | LICENSES (01) | NY |
T49408 | (02) |