Healthcare Provider Details

I. General information

NPI: 1669702965
Provider Name (Legal Business Name): PHILIP J BENYO, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 S OLD TURNPIKE RD
DRUMS PA
18222-1720
US

IV. Provider business mailing address

PO BOX 395
DRUMS PA
18222-0395
US

V. Phone/Fax

Practice location:
  • Phone: 570-788-6363
  • Fax:
Mailing address:
  • Phone: 570-788-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD-022634-E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA-051116
License Number StatePA

VIII. Authorized Official

Name: PHILIP JOHN BENYO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 570-788-6363