Healthcare Provider Details

I. General information

NPI: 1376867325
Provider Name (Legal Business Name): BENOIT R BEWLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COLUMBIA ST SUITE 200
POUGHKEEPSIE NY
12601-3923
US

IV. Provider business mailing address

1351 ROUTE 55 SUITE 101
LAGRANGEVILLE NY
12540-5108
US

V. Phone/Fax

Practice location:
  • Phone: 845-473-1188
  • Fax:
Mailing address:
  • Phone: 845-475-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number266191
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number266191
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: