Provider Information for 1265889109
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ETHAN LEVITAN BERNSTEIN M.D.
Sex: Male
NPI: 1265889109
Last Updated: 2024-05-07
Certification Date: 2024-05-07
Certification Date: 2024-05-07
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1265889109 | ||||||||||||||||
| Enumeration Date | 2016-05-20 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 263 FARMINGTON AVE FARMINGTON, CT 06030-0001 United States Phone: 860-679-2000 | Fax: | ||||||||||||||||
| Primary Practice Address | 263 FARMINGTON AVE FARMINGTON, CT 06030-0001 United States Phone: 860-679-2000 | Fax: | ||||||||||||||||
| Secondary Practice Address(es) | 789 HOWARD AVE 20 YORK STREET, CB-2041 | ||||||||||||||||
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