Basic Information
| Provider Information | |||||||||
| NPI: | 1902818339 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERNSTEIN | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | REBBECA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | ANP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VEGA | ||||||||
| OtherFirstName: | MARIA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | POB 1012 | ||||||||
| Address2: | PORT WASHINGTON | ||||||||
| City: | PORT WASHINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115761353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166292469 | ||||||||
| FaxNumber: | 5166292027 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 PORT WASHINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | ROSLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115761353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166292469 | ||||||||
| FaxNumber: | 5166292027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 06/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | F301593 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 02708556 | 05 | NY | MEDICAID |