Provider Demographics
NPI:1699313734
Name:BIENENFELD, JEREMY MARK
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:MARK
Last Name:BIENENFELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 MARCUS AVE STE M200
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-3000
Mailing Address - Country:US
Mailing Address - Phone:516-204-4242
Mailing Address - Fax:347-236-3163
Practice Address - Street 1:1991 MARCUS AVE STE M200
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-3000
Practice Address - Country:US
Practice Address - Phone:516-204-4242
Practice Address - Fax:347-236-3163
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program