Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 027494 | CT |
NPI | 1003884735 |
---|---|
Provider Name | Jeffrey M Bernstein |
First Address | Middletown, CT 06457-3654 |
Second Address | Middletown, CT 06457-3654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 18/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
027494 | CT LICENSE (01) | CT |
D 76956 | (02) | CT |