Healthcare Provider Details

I. General information

NPI: 1336468008
Provider Name (Legal Business Name): STEVEN R. BENDER,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 N MAIN ST
PLEASANTVILLE NJ
08232-1036
US

IV. Provider business mailing address

1425 N MAIN ST
PLEASANTVILLE NJ
08232-1036
US

V. Phone/Fax

Practice location:
  • Phone: 609-646-4220
  • Fax: 609-646-0628
Mailing address:
  • Phone: 609-646-4220
  • Fax: 609-646-0628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number25MD00121700
License Number StateNJ

VIII. Authorized Official

Name: STEVEN RICHARD BENDER
Title or Position: PRESIDENT
Credential: P.C.
Phone: 606-646-4220