Healthcare Provider Details

I. General information

NPI: 1689746752
Provider Name (Legal Business Name): GARRETT H. BENNETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E 61ST ST SUITE 7C
NEW YORK NY
10065-8183
US

IV. Provider business mailing address

115 E 61ST ST SUITE 7C
NEW YORK NY
10065-8183
US

V. Phone/Fax

Practice location:
  • Phone: 212-980-2600
  • Fax: 212-991-3009
Mailing address:
  • Phone: 212-980-2600
  • Fax: 212-991-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number219211
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: