Healthcare Provider Details

I. General information

NPI: 1215167945
Provider Name (Legal Business Name): BENNU INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 WASHINGTON RD STE 106
MOUNT LEBANON PA
15228-1901
US

IV. Provider business mailing address

226 PLEASANT AVE STE 4
MC MURRAY PA
15317-2938
US

V. Phone/Fax

Practice location:
  • Phone: 412-303-1599
  • Fax:
Mailing address:
  • Phone: 412-303-1599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHERINE ANN KWIATKOWSKI
Title or Position: PRESIDENT
Credential: MD
Phone: 412-303-1599