Provider Demographics
NPI:1821255639
Name:ANDREW BIENSTOCK O.D. PLLC
Entity Type:Organization
Organization Name:ANDREW BIENSTOCK O.D. PLLC
Other - Org Name:SPARE PAIR VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:BIENSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-987-2020
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005943152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100078333Medicare PIN
NY4976600001Medicare NSC