Provider Demographics
NPI:1306160593
Name:BERNSTEIN, FREDERIC JACOB (DO)
Entity type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:JACOB
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 TAMARACK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-5562
Mailing Address - Country:US
Mailing Address - Phone:860-647-8282
Mailing Address - Fax:860-647-8399
Practice Address - Street 1:2701 TAMARACK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-5562
Practice Address - Country:US
Practice Address - Phone:860-647-8282
Practice Address - Fax:860-647-8399
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP100364382080P0202X
CT499642080P0202X, 208000000X
CA20A10024390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program