MEDICARE: MARIE A BENTSIANOV M.D.

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	207R00000X	Internal Medicine Physician	210753	NY
2	207RN0300X	Nephrology Physician	210753	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P2908147	OTHER	NY	OXFORD
2	3399506	OTHER	NY	GHI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285631101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE A BENTSIANOV M.D.

Provider Business Mailing Address
First Line	:	40 W BRIGHTON AVE
Second Line	:	SUITE 103
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4901
Country	:	US
Telephone Number	:	718-743-0464
Fax Number	:	718-996-1123

Provider Business Practice Location Address
First Line	:	40 W BRIGHTON AVE
Second Line	:	SUITE 103
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4901
Country	:	US
Telephone Number	:	718-743-0464
Fax Number	:	718-996-1123

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	06/04/2013

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