=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417013053
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ESTELLE P BENDER MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 EAST END AVENUE LA
-----------------------------------------------------
City | NYC
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-717-0021
-----------------------------------------------------
Fax | 212-570-4165
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 EAST END AVENUE LA
-----------------------------------------------------
City | NYC
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-717-0021
-----------------------------------------------------
Fax | 212-570-4165
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 103643
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------