Provider Demographics
NPI:1568597334
Name:BENDERSON, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:BENDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1200 E.RIDGEWOOD AVENUE
Mailing Address - Street 2:SUITE 213WEST
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3937
Mailing Address - Country:US
Mailing Address - Phone:201-612-0044
Mailing Address - Fax:201-612-9446
Practice Address - Street 1:1200 E. RIDGEWOOD AVENUE
Practice Address - Street 2:SUITE 213 WEST
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3937
Practice Address - Country:US
Practice Address - Phone:201-612-0044
Practice Address - Fax:201-612-9446
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0065278207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD413311100Medicaid
MDKN35Q886Medicare PIN
MD751LQ885Medicare PIN
DC022247M24Medicare PIN