Provider Demographics
NPI:1285980078
Name:KOROTKIN, BERNARD STEVEN (RN)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:STEVEN
Last Name:KOROTKIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SANATORIUM RD
Mailing Address - Street 2:ROBERT L. YEAGER HEALTH CENTER BLDG. D
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970
Mailing Address - Country:US
Mailing Address - Phone:845-364-2252
Mailing Address - Fax:845-364-2149
Practice Address - Street 1:50 SANATORIUM RD
Practice Address - Street 2:ROBERT L. YEAGER HEALTH CENTER BLDG. D
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970
Practice Address - Country:US
Practice Address - Phone:845-364-2252
Practice Address - Fax:845-364-2149
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22641871163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)