MEDICARE: STANFORD BENNETT MD

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	207R00000X	Internal Medicine Physician	5390584	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	10102747	OTHER	CDPHP
2	GHI -PPO	OTHER	2589257
3	000000093159	OTHER	GHI-HMO
4	5294204	OTHER	CIGNA PROVIDER ID
5	129SD1	OTHER	EMPIRE BC-BS
6	2545905	OTHER	UNITED HEALTHCARE
7	1092475	OTHER	AETNA-HMO
8	3C5202	OTHER	HEALTHNET-GROUP PIN
9	7530743	OTHER	AETNA-PPO
10	050922000003	OTHER	FIDELIS CARE OF NY
11	388166	OTHER	MVP HEALTHPLAN
12	P3609126	OTHER	OXFORD HEALTH PLAN

General Provider Information

NPI Number	:	1871586354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANFORD BENNETT MD

Provider Business Mailing Address
First Line	:	1838 COMMERCE ST
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4400
Country	:	US
Telephone Number	:	914-962-3500
Fax Number	:	914-245-7875

Provider Business Practice Location Address
First Line	:	1838 COMMERCE ST
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4400
Country	:	US
Telephone Number	:	914-962-3500
Fax Number	:	914-245-7875

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	09/29/2011

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Directions to “ STANFORD BENNETT MD” Practice Location

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