Healthcare Provider Details

I. General information

NPI: 1245622661
Provider Name (Legal Business Name): CHENEL BENNETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2015
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date: 07/24/2015
Reactivation Date: 08/03/2022

III. Provider practice location address

326 E 149TH ST
BRONX NY
10451-5602
US

IV. Provider business mailing address

326 E 149TH ST
BRONX NY
10451-5602
US

V. Phone/Fax

Practice location:
  • Phone: 646-680-5200
  • Fax:
Mailing address:
  • Phone: 646-680-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number689543
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number349532
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: