Basic Information
| Provider Information | |||||||||
| NPI: | 1609880350 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERNSTEIN | ||||||||
| FirstName: | MYRON | ||||||||
| MiddleName: | Z | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 RINGLING BLVD | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342376102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9418612900 | ||||||||
| FaxNumber: | 9418612719 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 RINGLING BLVD | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342376102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9418612900 | ||||||||
| FaxNumber: | 9418612719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 03/23/2017 | ||||||||
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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 | 213E00000X | 00334 | MD | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0103X | PO545 | FL | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | PO 545 | 01 | FL | MEDICAL LICENSE | OTHER |