Provider Demographics
NPI:1699167510
Name:BERNATH, JAKE
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:BERNATH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282D CEDAR BRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4265
Mailing Address - Country:US
Mailing Address - Phone:732-200-1282
Mailing Address - Fax:
Practice Address - Street 1:282D CEDAR BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4265
Practice Address - Country:US
Practice Address - Phone:732-200-1282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications