Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 01870 | CT |
Y | 207RA0401X | Internist - Addiction Medicine | 018720 | CT |
NPI | 1720017056 |
---|---|
Provider Name | Dr. Jay B Benson |
First Address | Rocky Hill, CT 06067-1800 |
Second Address | Rocky Hill, CT 06067-1800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 04/09/2020 |