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General NPI Number Information
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NPI Number | 1215681515
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Entity Type | Individual
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Provider Name | KIMBERLY ANN BENTON
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Gender | Female
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Dates
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Enumeration Date | 02/07/2022
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 4104 VESTAL RD STE 101
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City | VESTAL
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State | NY
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Zip | 13850-3500
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Country | US
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Telephone | 607-235-3980
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Fax |
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Provider Business Mailing Address
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Address Line | 67 HILLVIEW DR
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City | BIG FLATS
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State | NY
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Zip | 14814-7954
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Country | US
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Telephone | 607-425-1900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 261936031
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License Number State | NY
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