Provider Demographics
NPI:1043250707
Name:BEENSTOCK, STEVEN M (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:BEENSTOCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GRAND ST
Mailing Address - Street 2:FL 3
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-987-3906
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:10 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-1304
Practice Address - Country:US
Practice Address - Phone:201-529-0033
Practice Address - Fax:201-529-5913
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07314600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0123029OtherGHI PPO
NJ1246768OtherAETNA HMO
NJ7920432OtherAETNA PPO
NJ2785652000OtherAMERIHEALTH
NJP00475866OtherRAILROAD MEDICARE
NJ3K3090OtherHEALTHNET
NJP3672900OtherOXFORD
NJ5772U1OtherEMPIRE BC/BS
NJ8824002Medicaid
NJ1246768OtherAETNA HMO
NJ053374CBCMedicare PIN