=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730122359
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENARDOT PEDIATRICS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2006
-----------------------------------------------------
Last Update Date | 06/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 58 ELM ST
-----------------------------------------------------
City | MALONE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12953-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-483-5800
-----------------------------------------------------
Fax | 518-483-1113
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 58 ELM STREET
-----------------------------------------------------
City | MALONE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-483-5800
-----------------------------------------------------
Fax | 481-483-1113
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER/BILLING SPECIALIST
-----------------------------------------------------
Name | MISS LISA A GUIFFRIDA
-----------------------------------------------------
Credential | CPC
-----------------------------------------------------
Telephone | 518-483-5800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 229747
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------