Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 219211 | NY |
NPI | 1689746752 |
---|---|
Provider Name | Garrett H. Bennett |
First Address | New York, NY 10065-8183 |
Second Address | New York, NY 10065-8183 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 10/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02656504 | (05) | NY |
I17392 | (02) | NY |