Healthcare Provider Details

I. General information

NPI: 1316753031
Provider Name (Legal Business Name): SERGE-ALAIN BENOIT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 PIERMONT AVE APT 2C
NYACK NY
10960-4648
US

IV. Provider business mailing address

294 PIERMONT AVE APT 2C
NYACK NY
10960-4648
US

V. Phone/Fax

Practice location:
  • Phone: 845-405-6524
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number198274
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number18289
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number773401
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: