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General NPI Number Information
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NPI Number | 1992038616
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Entity Type | Organization
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Legal Business Name | SCOTT BIENENFELD, MD LLC
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 06/09/2010
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Provider Practice Location Address
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Address Line | 33 PLYMOUTH ST SUITE 104
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2607
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Country | US
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Telephone | 973-509-1444
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Fax |
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Provider Business Mailing Address
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Address Line | 33 PLYMOUTH ST SUITE 104
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2607
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Country | US
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Telephone | 973-509-1444
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SCOTT BIENENFELD
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Credential | M.D.
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Telephone | 973-509-1444
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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 | MA07806800
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License Number State | NJ
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