1962776211 NPI number — MRS. AMANDA MARIE BENDER MS, OTR/L

Table of content: MRS. AMANDA MARIE BENDER MS, OTR/L (NPI 1962776211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962776211 NPI number — MRS. AMANDA MARIE BENDER MS, OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENDER
Provider First Name:
AMANDA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILSON
Provider Other First Name:
AMANDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962776211
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
273 HICKORY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEARNY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07032-3421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-240-7404
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 BERGEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07107-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-972-0186
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  46TR00491500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com