Healthcare Provider Details

I. General information

NPI: 1427980028
Provider Name (Legal Business Name): LUMINARY MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 RIVEREDGE RD STE 2
TENAFLY NJ
07670-3212
US

IV. Provider business mailing address

30 RIVEREDGE RD STE 2
TENAFLY NJ
07670-3212
US

V. Phone/Fax

Practice location:
  • Phone: 917-446-6829
  • Fax:
Mailing address:
  • Phone: 917-446-6829
  • Fax: 646-349-4435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT BIENENFELD
Title or Position: PRESIDENT
Credential: MD
Phone: 917-446-6829