Provider Demographics
NPI:1992770705
Name:BERNAL-SCHNATTER, ILEANA (MD)
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:BERNAL-SCHNATTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1364
Mailing Address - Country:US
Mailing Address - Phone:908-301-2600
Mailing Address - Fax:908-301-5456
Practice Address - Street 1:313 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1364
Practice Address - Country:US
Practice Address - Phone:908-301-2600
Practice Address - Fax:908-301-5456
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA062575002084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF19416Medicare UPIN