Basic Information
| Provider Information | |||||||||
| NPI: | 1598735599 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BORNSTEIN | ||||||||
| FirstName: | BARRY | ||||||||
| MiddleName: | YVES | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15645 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891145645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027371880 | ||||||||
| FaxNumber: | 7027375988 | ||||||||
| Practice Location | |||||||||
| Address1: | 5820 S EASTERN AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891193002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027371880 | ||||||||
| FaxNumber: | 7027375988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 01/17/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA920 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | CI7026 | 01 | NV | GROUP RAILROAD MEDICARE | OTHER | P00401651 | 01 | NV | RAILROAD MEDICARE | OTHER | 100507665 | 05 | NV | MEDICAID |