Provider Demographics
NPI:1154416949
Name:BERNASCONI, JAY ALLAN (DPT, OCS)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:ALLAN
Last Name:BERNASCONI
Suffix:
Gender:M
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 TOTMAN ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7564
Mailing Address - Country:US
Mailing Address - Phone:617-770-4167
Mailing Address - Fax:617-770-0971
Practice Address - Street 1:21 TOTMAN ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7564
Practice Address - Country:US
Practice Address - Phone:617-770-4167
Practice Address - Fax:617-770-0971
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABEY65909OtherBC/BS OF MA.
Y65909Medicare PIN