Provider Demographics
NPI:1841340387
Name:HOLLY BIENENSTOCK, DOPC
Entity type:Organization
Organization Name:HOLLY BIENENSTOCK, DOPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-767-3161
Mailing Address - Street 1:14 MAPLE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2946
Mailing Address - Country:US
Mailing Address - Phone:516-767-3161
Mailing Address - Fax:
Practice Address - Street 1:14 MAPLE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2946
Practice Address - Country:US
Practice Address - Phone:516-767-3161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWANH11Medicare PIN