Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 0129271 | NY |
NPI | 1922366152 |
---|---|
Provider Name | Mrs. Beth Sara Bennett |
First Address | Cedarhurst, NY 11516-2303 |
Second Address | Cedarhurst, NY 11516-2303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2012 |
Last Update Date | 25/04/2012 |