Healthcare Provider Details

I. General information

NPI: 1538129937
Provider Name (Legal Business Name): BENTO R MASCARENHAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 PONDFIELD RD
BRONXVILLE NY
10708-3809
US

IV. Provider business mailing address

785 MAMARONECK AVE
WHITE PLAINS NY
10605-2523
US

V. Phone/Fax

Practice location:
  • Phone: 914-337-5879
  • Fax:
Mailing address:
  • Phone: 914-948-6405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number107303
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: