Basic Information
| Provider Information | |||||||||
| NPI: | 1912323379 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KITCHEN BENT | ||||||||
| FirstName: | JANINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 E BOSTON POST RD | ||||||||
| Address2: | |||||||||
| City: | MAMARONECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105434115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9148209095 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 E BOSTON POST RD | ||||||||
| Address2: | |||||||||
| City: | MAMARONECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105434115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9148209095 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2014 | ||||||||
| LastUpdateDate: | 03/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | 008821-1 | NY | Y | Eye and Vision Services Providers | Technician/Technologist | Optician |
ID Information
| ID | Type | State | Issuer | Description | 008821-1 | 01 | NY | OPTICIAN LICENSE | OTHER |