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General NPI Number Information
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NPI Number | 1114168408
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Entity Type | Organization
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Legal Business Name | MATTHEW A. BENNETT MD PLLC
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Dates
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Enumeration Date | 03/16/2009
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Last Update Date | 03/16/2009
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Provider Practice Location Address
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Address Line | 624 RIVER RD SUITE #1
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-6563
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Country | US
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Telephone | 716-332-2300
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Fax | 716-332-2280
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Provider Business Mailing Address
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Address Line | 624 RIVER RD SUITE #1
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-6563
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Country | US
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Telephone | 716-332-2300
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Fax | 716-332-2280
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW ANTHONY BENNETT
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Credential | M.D.
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Telephone | 716-332-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 250570
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License Number State | NY
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