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General NPI Number Information
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NPI Number | 1457761967
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Entity Type | Organization
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Legal Business Name | REBOUND NEW YORK MEDICAL, PC
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 07/06/2016
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Provider Practice Location Address
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Address Line | 67 IRVING PL 10TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10003-2202
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Country | US
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Telephone | 917-446-6829
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Fax | 646-349-4435
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Provider Business Mailing Address
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Address Line | 127 W 79TH ST SUITE 1-N
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City | NEW YORK
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State | NY
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Zip | 10024-6416
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Country | US
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Telephone | 917-446-6829
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Fax | 646-349-4435
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. SCOTT BIENENFELD
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Credential | M.D.
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Telephone | 917-446-6829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 211810
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License Number State | NY
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