Provider Demographics
NPI:1063435790
Name:BERNARD, ANDREW
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:BERNARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 E MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8413
Mailing Address - Country:US
Mailing Address - Phone:631-665-1325
Mailing Address - Fax:
Practice Address - Street 1:387 E MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8413
Practice Address - Country:US
Practice Address - Phone:631-665-1325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035143-11223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY035143-1OtherLICENSES
T49408Medicare UPIN