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General NPI Number Information
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NPI Number | 1376604207
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Entity Type | Individual
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Provider Name | JONATHAN BENTWICH PH.D.
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Gender | Male
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1230 AVE OF THE AMERICAS 7TH FLOOR ROCKEFELLER CENTER
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City | NEW YORK
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State | NY
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Zip | 10020-1517
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Country | US
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Telephone | 646-756-2820
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Fax |
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Provider Business Mailing Address
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Address Line | 85 FAIRFIELD WAY APT 8
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City | COMMACK
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State | NY
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Zip | 11725-3426
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Country | US
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Telephone | 631-486-5191
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 016785
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License Number State | NY
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