Provider Demographics
NPI:1679816060
Name:FLEMING, BENDETTA (MSED)
Entity Type:Individual
Prefix:MS
First Name:BENDETTA
Middle Name:
Last Name:FLEMING
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 1:30 NEWPORT PARKWAY
Mailing Address - Street 2:507
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310
Mailing Address - Country:US
Mailing Address - Phone:917-723-7362
Mailing Address - Fax:
Practice Address - Street 1:30 NEWPORT PARKWAY
Practice Address - Street 2:507
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310
Practice Address - Country:US
Practice Address - Phone:917-723-7362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225500000X
NY444934235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist