Provider Demographics
NPI:1184142184
Name:BENTLEY, KEVIN J (RPA-C)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7670 OMNITECH PL
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9782
Mailing Address - Country:US
Mailing Address - Phone:585-275-5321
Mailing Address - Fax:585-276-1202
Practice Address - Street 1:7670 OMNITECH PL
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9782
Practice Address - Country:US
Practice Address - Phone:585-275-5321
Practice Address - Fax:585-276-1202
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21245367500000X
NY021245363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered