Provider Demographics
NPI:1538856729
Name:BERNARD, BENJAMIN (EMT-BASIC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:BERNARD
Suffix:
Gender:M
Credentials:EMT-BASIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 FIRESIDE CT
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:NY
Mailing Address - Zip Code:12563-2667
Mailing Address - Country:US
Mailing Address - Phone:845-800-4366
Mailing Address - Fax:
Practice Address - Street 1:6 GARRETT PLACE
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512
Practice Address - Country:US
Practice Address - Phone:845-225-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY436966146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic