Provider Demographics
NPI:1992496988
Name:BERNHARDT, ERIN PAIGE
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:PAIGE
Last Name:BERNHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 BRYSON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2453
Mailing Address - Country:US
Mailing Address - Phone:646-752-4920
Mailing Address - Fax:
Practice Address - Street 1:1100 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3410
Practice Address - Country:US
Practice Address - Phone:866-707-8669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2631152174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist