Provider Demographics
NPI:1376604207
Name:BENTWICH, JONATHAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:BENTWICH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 FAIRFIELD WAY APT 8
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3426
Mailing Address - Country:US
Mailing Address - Phone:631-486-5191
Mailing Address - Fax:
Practice Address - Street 1:1230 AVE OF THE AMERICAS 7TH FLOOR
Practice Address - Street 2:ROCKEFELLER CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10020-1517
Practice Address - Country:US
Practice Address - Phone:646-756-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016785103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist