Provider Demographics
NPI:1720189160
Name:BIENSTOCK, ANDREW IAN
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:IAN
Last Name:BIENSTOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1900
Mailing Address - Country:US
Mailing Address - Phone:718-987-2020
Mailing Address - Fax:718-987-2202
Practice Address - Street 1:1300 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1900
Practice Address - Country:US
Practice Address - Phone:718-987-2020
Practice Address - Fax:718-987-2202
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005943152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4976600001Medicare NSC
NYA400078335Medicare PIN