Healthcare Provider Details

I. General information

NPI: 1285280743
Provider Name (Legal Business Name): HADASSAH BENNETT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LATTIMORE RD STE 258
ROCHESTER NY
14620-4155
US

IV. Provider business mailing address

13540 78TH DR
FLUSHING NY
11367-3236
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-8020
  • Fax:
Mailing address:
  • Phone: 201-396-6206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF344828
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: