Healthcare Provider Details

I. General information

NPI: 1588375497
Provider Name (Legal Business Name): BENJAMIN JAMES HAYLETT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 ESSJAY RD
WILLIAMSVILLE NY
14221-5795
US

IV. Provider business mailing address

425 ESSJAY RD STE 170
WILLIAMSVILLE NY
14221-8235
US

V. Phone/Fax

Practice location:
  • Phone: 716-630-1050
  • Fax: 716-250-5925
Mailing address:
  • Phone: 716-630-1219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number029371-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: