Provider Demographics
NPI:1457761967
Name:REBOUND NEW YORK MEDICAL, PC
Entity Type:Organization
Organization Name:REBOUND NEW YORK MEDICAL, PC
Other - Org Name:SCOTT BIENENFELD, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BIENENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-446-6829
Mailing Address - Street 1:127 W 79TH ST
Mailing Address - Street 2:SUITE 1-N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6416
Mailing Address - Country:US
Mailing Address - Phone:917-446-6829
Mailing Address - Fax:646-349-4435
Practice Address - Street 1:67 IRVING PL
Practice Address - Street 2:10TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2202
Practice Address - Country:US
Practice Address - Phone:917-446-6829
Practice Address - Fax:646-349-4435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2118102084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty