Basic Information
Provider Information
NPI: 1003416041
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BERNATH
FirstName: JAMES
MiddleName: BRIAN
NamePrefix:  
NameSuffix:  
Credential: HAS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8181 NW 154TH ST STE 200
Address2:  
City: MIAMI LAKES
State: FL
PostalCode: 330165861
CountryCode: US
TelephoneNumber: 3055956200
FaxNumber: 7869074485
Practice Location
Address1: 601 N FLAMINGO RD STE 210
Address2:  
City: PEMBROKE PINES
State: FL
PostalCode: 330281009
CountryCode: US
TelephoneNumber: 9548171945
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/29/2020
LastUpdateDate: 05/05/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/05/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
237700000XAS2889FLY Speech, Language and Hearing Service ProvidersHearing Instrument Specialist 

No ID Information.


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