Provider Demographics
NPI:1043212681
Name:BENDER, JESSICA MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MARIE
Last Name:BENDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:HEENEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2 ROSELL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-1400
Mailing Address - Country:US
Mailing Address - Phone:518-877-8900
Mailing Address - Fax:518-877-8908
Practice Address - Street 1:2 ROSELL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-1400
Practice Address - Country:US
Practice Address - Phone:518-877-8900
Practice Address - Fax:518-877-8908
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022761-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000081192OtherGHI HMO
NY200857640-02OtherIMC/FIRST HEALTH
NY982944OtherGALAXY HEALTH NETWORK
NY000416429001OtherBLUE SHEILD NENY
NY370167OtherMVP
NY10086375OtherCDPHP
NYQ10T61OtherBLUE CROSS
NY00200857640OtherUNIVERA
NY6697632OtherGHI PPO/CBP
NY200857640-02OtherPRISM
NY7123578OtherAETNA
NY839169OtherMPN
NY000000081192OtherGHI HMO
NY370167OtherMVP