Individual
MRS. JAMIE BERNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
803 1ST ST, WATERVLIET, NY 12189-3502
(518) 248-2669
Mailing address
803 1ST ST, WATERVLIET, NY 12189-3502
(518) 248-2669
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
687458194
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5548566
ASSIGNED FILING NUMBER WITH NEW YORK STATE
—
Enumeration date
05/09/2019
Last updated
05/09/2019
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