Healthcare Provider Details

I. General information

NPI: 1255593588
Provider Name (Legal Business Name): LAURA ANN BENTIVENGA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1985 CROMPOND RD
CORTLANDT MANOR NY
10567-4146
US

IV. Provider business mailing address

2649 STRANG BLVD STE 304
YORKTOWN HEIGHTS NY
10598-2938
US

V. Phone/Fax

Practice location:
  • Phone: 914-736-0703
  • Fax: 914-736-9234
Mailing address:
  • Phone: 914-739-0087
  • Fax: 914-737-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF335563
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: