MEDICARE: MARSHA BIENENSTOCK DPM

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	213E00000X	Podiatrist	004207	NY

General Provider Information

NPI Number	:	1649341959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHA BIENENSTOCK DPM

Provider Business Mailing Address
First Line	:	46 HENRIETTA AVE
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-5126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	585 KNICKERBOCKER AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-4742
Country	:	US
Telephone Number	:	718-417-8087
Fax Number	:

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

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	07/07/2009

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