Healthcare Provider Details

I. General information

NPI: 1043291792
Provider Name (Legal Business Name): ROBERT BENTIVEGNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 DUBOIS ST
NEWBURGH NY
12550-4851
US

IV. Provider business mailing address

2 CATHARINE ST
POUGHKEEPSIE NY
12601-3100
US

V. Phone/Fax

Practice location:
  • Phone: 845-561-4400
  • Fax: 845-790-2675
Mailing address:
  • Phone: 866-885-2318
  • Fax: 845-790-2675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number200001-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: