Basic Information
| Provider Information | |||||||||
| NPI: | 1871811711 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERNARDO | ||||||||
| FirstName: | RAFFAELE | ||||||||
| MiddleName: | MARIO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 E 210TH ST | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104672401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189205224 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3230 BAINBRIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188825482 | ||||||||
| FaxNumber: | 7188825725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2010 | ||||||||
| LastUpdateDate: | 06/08/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 25MB09323700 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | 1.055013-DO | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | 291639 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.