MEDICARE: MRS. JESSICA MARIE BENDER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	022761-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000081192	OTHER	NY	GHI HMO
2	200857640-02	OTHER	NY	IMC/FIRST HEALTH
3	982944	OTHER	NY	GALAXY HEALTH NETWORK
4	000416429001	OTHER	NY	BLUE SHEILD NENY
5	370167	OTHER	NY	MVP
6	10086375	OTHER	NY	CDPHP
7	Q10T61	OTHER	NY	BLUE CROSS
8	00200857640	OTHER	NY	UNIVERA
9	6697632	OTHER	NY	GHI PPO/CBP
10	200857640-02	OTHER	NY	PRISM
11	7123578	OTHER	NY	AETNA
12	839169	OTHER	NY	MPN

General Provider Information

NPI Number	:	1043212681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA MARIE BENDER PT

Provider Business Mailing Address
First Line	:	2 ROSELL DR
Second Line	:	SUITE 100
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019-1400
Country	:	US
Telephone Number	:	518-877-8900
Fax Number	:	518-877-8908

Provider Business Practice Location Address
First Line	:	2 ROSELL DR
Second Line	:	SUITE 100
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019-1400
Country	:	US
Telephone Number	:	518-877-8900
Fax Number	:	518-877-8908

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	07/08/2007

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