Provider Demographics
NPI:1831151356
Name:BIENSTOCK, DOUGLAS (D O)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:BIENSTOCK
Suffix:
Gender:
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-2679
Mailing Address - Country:US
Mailing Address - Phone:201-882-1050
Mailing Address - Fax:973-427-0604
Practice Address - Street 1:150 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-2679
Practice Address - Country:US
Practice Address - Phone:201-882-1050
Practice Address - Fax:201-882-1040
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB064309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ454283UKXMedicare PIN