Basic Information
Provider Information
NPI: 1669565982
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BERNSTEIN
FirstName: JONATHAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 500 UNIVERSITY DRIVE
Address2:  
City: HERSHEY
State: PA
PostalCode: 170330858
CountryCode: US
TelephoneNumber: 8002431455
FaxNumber:  
Practice Location
Address1: 500 UNIVERSITY DRIVE
Address2:  
City: HERSHEY
State: PA
PostalCode: 170330858
CountryCode: US
TelephoneNumber: 8002431455
FaxNumber: 7175314789
Other Information
ProviderEnumerationDate: 09/30/2006
LastUpdateDate: 02/16/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/16/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0207XMD470228PAY Allopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology

No ID Information.


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