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NPI Code Detail

MEDICARE: DR. MARC IRWIN BIENENSTOCK D.D.S.

MEDICARE: DR. MARC IRWIN BIENENSTOCK D.D.S.
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
11223G0001XGeneral Practice Dentistry031415NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316940158
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARC IRWIN BIENENSTOCK D.D.S.
Provider Business Mailing Address
First Line : 1530 PENNSYLVANIA AVE
Second Line : APT 6H
City : BROOKLYN
State : NY
Zip : 11239-2607
Country : US
Telephone Number : 516-384-8745
Fax Number :
Provider Business Practice Location Address
First Line : 3809 JUNCTION BLVD
Second Line : FL 2
City : CORONA
State : NY
Zip : 11368-2153
Country : US
Telephone Number : 718-639-7100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 07/08/2007

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