Basic Information
| Provider Information | |||||||||
| NPI: | 1043250707 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEENSTOCK | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 GRAND ST | ||||||||
| Address2: | FL 3 | ||||||||
| City: | WARWICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109901035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8459873906 | ||||||||
| FaxNumber: | 8459875979 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 FRANKLIN TPKE | ||||||||
| Address2: | |||||||||
| City: | MAHWAH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074301304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015290033 | ||||||||
| FaxNumber: | 2015295913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 02/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MB07314600 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0123029 | 01 | NJ | GHI PPO | OTHER | 1246768 | 01 | NJ | AETNA HMO | OTHER | 7920432 | 01 | NJ | AETNA PPO | OTHER | 2785652000 | 01 | NJ | AMERIHEALTH | OTHER | P00475866 | 01 | NJ | RAILROAD MEDICARE | OTHER | 3K3090 | 01 | NJ | HEALTHNET | OTHER | P3672900 | 01 | NJ | OXFORD | OTHER | 5772U1 | 01 | NJ | EMPIRE BC/BS | OTHER | 8824002 | 05 | NJ | MEDICAID |