Healthcare Provider Details

I. General information

NPI: 1609992106
Provider Name (Legal Business Name): SCOTT ANDREW BENDELL MAC CA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 ATLANTIC CITY BLVD
BEACHWOOD NJ
08722-2972
US

IV. Provider business mailing address

245 ATLANTIC CITY BLVD
BEACHWOOD NJ
08722-2972
US

V. Phone/Fax

Practice location:
  • Phone: 848-221-2791
  • Fax: 848-221-2796
Mailing address:
  • Phone: 732-720-9653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00035200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: