Healthcare Provider Details

I. General information

NPI: 1831151356
Provider Name (Legal Business Name): DOUGLAS BIENSTOCK D. O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 LAFAYETTE AVE
HAWTHORNE NJ
07506-2679
US

IV. Provider business mailing address

150 LAFAYETTE AVE
HAWTHORNE NJ
07506-2679
US

V. Phone/Fax

Practice location:
  • Phone: 201-882-1050
  • Fax: 201-882-1040
Mailing address:
  • Phone: 201-882-1050
  • Fax: 973-427-0604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB064309
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: