Individual
BERNARD MEMBER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
103 W SENECA ST, SUITE 303C, ITHACA, NY 14850-4145
(804) 339-2105
Mailing address
103 W SENECA ST, SUITE 303C, ITHACA, NY 14850-4145
(804) 339-2105
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
143064
NY
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
143064
NY
Other
Enumeration date
12/08/2008
Last updated
01/05/2012
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