Healthcare Provider Details

I. General information

NPI: 1346982683
Provider Name (Legal Business Name): BENJAMIN KINNEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 HILLTOP CTS
BUFFALO NY
14224-4210
US

IV. Provider business mailing address

21 HILLTOP CTS
BUFFALO NY
14224-4210
US

V. Phone/Fax

Practice location:
  • Phone: 716-870-4021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number649375-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: