Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 213757 | NY |
NPI | 1003986431 |
---|---|
Provider Name | James Bernasko |
First Address | East Setauket, NY 11733-4080 |
Second Address | East Setauket, NY 11733-4080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 19/11/2012 |