Healthcare Provider Details

I. General information

NPI: 1700527520
Provider Name (Legal Business Name): CHRISTINA ALEXIS BENNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 IRVING AVE
SYRACUSE NY
13210-1602
US

IV. Provider business mailing address

736 IRVING AVE
SYRACUSE NY
13210-1602
US

V. Phone/Fax

Practice location:
  • Phone: 315-470-7111
  • Fax: 315-470-2691
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number338842
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number338842
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: