Provider Demographics
NPI:1679858740
Name:BENDO, RANDOLPH (PT)
Entity Type:Individual
Prefix:MR
First Name:RANDOLPH
Middle Name:
Last Name:BENDO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8202 GRAND AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4133
Mailing Address - Country:US
Mailing Address - Phone:718-606-0849
Mailing Address - Fax:718-606-1077
Practice Address - Street 1:8202 GRAND AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4133
Practice Address - Country:US
Practice Address - Phone:718-606-0849
Practice Address - Fax:718-606-1077
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist