Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 189717 | NY |
NPI | 1003810714 |
---|---|
Provider Name | Judith H Benedict |
First Address | East Syracuse, NY 13057-4505 |
Second Address | Syracuse, NY 13210-1687 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 19/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F33734 | (02) |