Healthcare Provider Details

I. General information

NPI: 1962873968
Provider Name (Legal Business Name): DAVID BENDAVID
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 KINGS HWY
BROOKLYN NY
11223-1629
US

IV. Provider business mailing address

1315 GATEWAY BLVD
FAR ROCKAWAY NY
11691-5251
US

V. Phone/Fax

Practice location:
  • Phone: 718-787-1100
  • Fax:
Mailing address:
  • Phone: 718-787-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: