MEDICARE: MR. JOHN CHRISTOPHER BENDER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	021435-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200857640	OTHER	NY	TRPN/THREE RIVERS
2	982945	OTHER	NY	GALAXY HEALTH NETWORK
3	200857640	OTHER	NY	NOVA
4	10070721	OTHER	NY	CDPHP(GRP M479200857640)
5	Q10Z01	OTHER	NY	BLUE CROSS
6	00200857640	OTHER	NY	UNIVERA
7	416174001	OTHER	NY	GROUP-BLUE SHIELD NENY
8	7672208	OTHER	NY	AETNA
9	828360	OTHER	NY	MPN
10	200857640	OTHER	NY	TRICARE - GROUP
11	200857640	OTHER	NY	UNITED HEALTH CARE
12	362798	OTHER	NY	MVP
13	6697631	OTHER	NY	GHI PPO/CBP
14	000000081191	OTHER	NY	GHI HMO
15	000403779003	OTHER	NY	BLUE SHIELD NENY
16	200857640	OTHER	NY	STATEWIDE
17	200857640	OTHER	NY	SHARED HEALTH

General Provider Information

NPI Number	:	1588666192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN CHRISTOPHER BENDER PT

Provider Business Mailing Address
First Line	:	2 ROSELL DR
Second Line	:	SUITE 100
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019-1400
Country	:	US
Telephone Number	:	518-877-8900
Fax Number	:	518-877-8908

Provider Business Practice Location Address
First Line	:	2 ROSELL DR
Second Line	:	SUITE 100
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019-1400
Country	:	US
Telephone Number	:	518-877-8900
Fax Number	:	518-877-8908

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	08/22/2011

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