Provider Demographics
NPI:1386602605
Name:BENDER, DENNIS (PA)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:BENDER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HAGEN DR STE 220
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2666
Mailing Address - Country:US
Mailing Address - Phone:585-922-9770
Mailing Address - Fax:585-922-9777
Practice Address - Street 1:20 HAGEN DR STE 220
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2666
Practice Address - Country:US
Practice Address - Phone:585-922-9770
Practice Address - Fax:585-922-9777
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0026531363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY970028207OtherMEDICARE RAILROAD
NY109301BJOtherPREFERRED CARE
NYP019002653OtherBLUE CHOICE
NY11564228OtherCAQH
NY00355266Medicaid
NY9514078OtherIHA
NYJ400002605Medicare PIN
NY109301BJOtherPREFERRED CARE
NYCC7114Medicare ID - Type Unspecified