Healthcare Provider Details

I. General information

NPI: 1790746733
Provider Name (Legal Business Name): BENNETT SURGICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 NEW YORK AVENUE
HUNTINGTON NY
11743
US

IV. Provider business mailing address

382 NEW YORK AVENUE
HUNTINGTON NY
11743
US

V. Phone/Fax

Practice location:
  • Phone: 631-421-1771
  • Fax: 631-421-9861
Mailing address:
  • Phone: 631-421-1771
  • Fax: 631-421-9861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNY

VIII. Authorized Official

Name: MRS. KATIA E DONNELLY
Title or Position: PRESIDENT
Credential: RN
Phone: 631-421-1771