Individual
BERNARD WESLEY BENTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4355 147TH ST, FLUSHING, NY 11355-1736
(718) 762-0900
(718) 886-5659
Mailing address
560 S BROADWAY, HICKSVILLE, NY 11801-5027
(516) 933-2800
(516) 933-2809
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
192628
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01849650
—
NY
01
—
10766740
CAQH
NY
Enumeration date
06/09/2006
Last updated
12/11/2008
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