Provider Demographics
NPI:1043218597
Name:BENDER, STEVEN R (PC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:BENDER
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-1036
Mailing Address - Country:US
Mailing Address - Phone:609-646-4220
Mailing Address - Fax:609-646-0628
Practice Address - Street 1:1425 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-1036
Practice Address - Country:US
Practice Address - Phone:609-646-4220
Practice Address - Fax:609-646-0628
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00121700213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223374159OtherTIN
NJ223374159OtherTIN
NJT95860Medicare UPIN