Provider Demographics
NPI:1275359333
Name:BERNSTEIN, VLADIMIR JACOB (LIC PED)
Entity type:Individual
Prefix:MR
First Name:VLADIMIR
Middle Name:JACOB
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:LIC PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 NE 26TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1428
Mailing Address - Country:US
Mailing Address - Phone:954-736-1790
Mailing Address - Fax:954-736-1790
Practice Address - Street 1:1749 NE 26TH ST STE C
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1428
Practice Address - Country:US
Practice Address - Phone:954-736-1790
Practice Address - Fax:954-736-1790
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPED271224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist