Provider Demographics
NPI:1689668741
Name:BERNSTEIN, MICHAEL P (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:146 HAZARD AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4571
Mailing Address - Country:US
Mailing Address - Phone:860-763-3243
Mailing Address - Fax:860-763-3244
Practice Address - Street 1:146 HAZARD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4571
Practice Address - Country:US
Practice Address - Phone:860-763-3243
Practice Address - Fax:860-763-3244
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT27001207Y00000X, 207Y00000X
237700000X, 332B00000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT01270016Medicaid
CTHA5522OtherOXFORD HEALTH
CT027001OtherCONNECTICARE
CT010027001CT01OtherBLUE CROSS/BLUE SHIELD
CT4233447OtherAETNA
CT027001OtherCONNECTICARE
CT4233447OtherAETNA