MEDICARE: LEONARD A BENEDICT PHYSICIAN PC

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	174400000X	Specialist	126941	NY

General Provider Information

NPI Number	:	1740556968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEONARD A BENEDICT PHYSICIAN PC

Provider Business Mailing Address
First Line	:	433 UNIONDALE AVE
Second Line	:
City	:	UNIONDALE
State	:	NY
Zip	:	11553-2232
Country	:	US
Telephone Number	:	516-483-8798
Fax Number	:	516-483-4169

Provider Business Practice Location Address
First Line	:	433 UNIONDALE AVE
Second Line	:
City	:	UNIONDALE
State	:	NY
Zip	:	11553-2232
Country	:	US
Telephone Number	:	516-483-8798
Fax Number	:	516-483-4169

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LEONARD BENEDICT
Credential	:	M.D.
Telephone Number	:	516-483-8798

Provider Enumeration Date	:	04/02/2012
Last Update Date	:	04/19/2012

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