Healthcare Provider Details

I. General information

NPI: 1134193758
Provider Name (Legal Business Name): JON E BENTZ PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 HARRISBURG PIKE
LANCASTER PA
17601-2644
US

IV. Provider business mailing address

2100 HARRISBURG PIKE
LANCASTER PA
17601-2644
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-3172
  • Fax: 717-544-3229
Mailing address:
  • Phone: 717-544-3172
  • Fax: 717-544-3229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS004295L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: