Provider Demographics
NPI:1922166701
Name:BIENENFELD, JAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:BIENENFELD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-7182
Mailing Address - Country:US
Mailing Address - Phone:718-599-0753
Mailing Address - Fax:
Practice Address - Street 1:165 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7182
Practice Address - Country:US
Practice Address - Phone:718-599-0753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004939213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01258731Medicaid
NYU33852Medicare UPIN
NYP53901Medicare PIN