Healthcare Provider Details

I. General information

NPI: 1871266411
Provider Name (Legal Business Name): JACLYN BENZONI OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E MAIN ST
BABYLON NY
11702-3508
US

IV. Provider business mailing address

40 E MAIN ST
BABYLON NY
11702-3508
US

V. Phone/Fax

Practice location:
  • Phone: 631-587-2020
  • Fax: 631-587-2087
Mailing address:
  • Phone: 631-587-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JACLYN ANNE BENZONI
Title or Position: CEO
Credential: OD
Phone: 516-546-3227