Provider Demographics
NPI:1124280888
Name:MARTIN BIENENSTOCK
Entity type:Organization
Organization Name:MARTIN BIENENSTOCK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIENENSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-996-0300
Mailing Address - Street 1:2940 OCEAN PKWY STE 2G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8210
Mailing Address - Country:US
Mailing Address - Phone:718-996-0300
Mailing Address - Fax:718-996-0089
Practice Address - Street 1:2940 OCEAN PKWY STE 2G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8210
Practice Address - Country:US
Practice Address - Phone:718-996-0300
Practice Address - Fax:718-996-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00300312Medicaid