Provider Demographics
NPI:1104188150
Name:BENDIX, SUSAN LESLIE (MSED)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LESLIE
Last Name:BENDIX
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 OLIVER WAY
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5425
Mailing Address - Country:US
Mailing Address - Phone:516-868-4033
Mailing Address - Fax:
Practice Address - Street 1:2119 OLIVER WAY
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-5425
Practice Address - Country:US
Practice Address - Phone:516-868-4033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8010174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist