Healthcare Provider Details

I. General information

NPI: 1407510621
Provider Name (Legal Business Name): MICHAEL BENHAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 BANK ST
BATAVIA NY
14020-1616
US

IV. Provider business mailing address

1260 VEEDER DR
HEWLETT NY
11557-2526
US

V. Phone/Fax

Practice location:
  • Phone: 718-506-1115
  • Fax:
Mailing address:
  • Phone: 631-846-1677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number019326-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: