Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 35-055759 | OH |
NPI | 1043212772 |
---|---|
Provider Name | Dr. Jack Mark Bernstein |
First Address | Kettering, OH 45429-1272 |
Second Address | Kettering, OH 45429-1272 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 06/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0438922 | (05) | OH |
A72090 | (02) |