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General NPI Number Information
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NPI Number | 1780002717
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Entity Type | Individual
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Provider Name | LESLIE JACOB BENNY D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/07/2014
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 901 E OAK ST STE C
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City | KISSIMMEE
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State | FL
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Zip | 34744-5837
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Country | US
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Telephone | 386-561-9967
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Fax | 844-815-1446
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Provider Business Mailing Address
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Address Line | 795 PRIMERA BLVD STE 1001
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City | LAKE MARY
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State | FL
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Zip | 32746-2191
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Country | US
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Telephone | 386-561-9967
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Fax | 844-815-1446
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | OS17075
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License Number State | FL
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