Healthcare Provider Details

I. General information

NPI: 1174789127
Provider Name (Legal Business Name): NANCY JEAN BENTON L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 FLATIRON RD
BLOOMFIELD NY
14469-9316
US

IV. Provider business mailing address

3200 FLATIRON RD
BLOOMFIELD NY
14469-9316
US

V. Phone/Fax

Practice location:
  • Phone: 585-749-2013
  • Fax: 585-657-4804
Mailing address:
  • Phone: 585-749-2013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003872
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: