Healthcare Provider Details

I. General information

NPI: 1689000366
Provider Name (Legal Business Name): BRANDY BENJAMIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 MAIN ST
BINGHAMTON NY
13905-2579
US

IV. Provider business mailing address

303 MAIN ST
BINGHAMTON NY
13905-2579
US

V. Phone/Fax

Practice location:
  • Phone: 607-798-8058
  • Fax: 607-798-8328
Mailing address:
  • Phone: 607-798-8058
  • Fax: 607-798-8328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number546461
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number338343
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: