=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821024308
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL CARE FAMILY PRACTICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2006
-----------------------------------------------------
Last Update Date | 07/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 245 DIAMOND BRIDGE AVE
-----------------------------------------------------
City | HAWTHORNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07506-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-427-0600
-----------------------------------------------------
Fax | 973-427-0604
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 JENNY LANE
-----------------------------------------------------
City | WAYNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07470-1940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-427-0600
-----------------------------------------------------
Fax | 973-427-0604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DO/DIRECTOR
-----------------------------------------------------
Name | DOUGLAS BIENSTOCK
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 973-427-0604
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MB064309
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 25MD06430900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------