MEDICARE: PHILIP P. BENYO M.P.A.S., PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	MA051116	PA

General Provider Information

NPI Number	:	1518965664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP P. BENYO M.P.A.S., PA-C

Provider Business Mailing Address
First Line	:	PO BOX 1347
Second Line	:
City	:	KINGSTON
State	:	PA
Zip	:	18704-0347
Country	:	US
Telephone Number	:	570-288-8881
Fax Number	:	570-288-8065

Provider Business Practice Location Address
First Line	:	144 S OLD TURNPIKE RD
Second Line	:
City	:	DRUMS
State	:	PA
Zip	:	18222-1720
Country	:	US
Telephone Number	:	570-788-6363
Fax Number	:	570-788-7313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	03/29/2014

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