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NPI Code Detail

MEDICARE: ISAIAH BENNETT

MEDICARE: ISAIAH BENNETT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1053833467
Entity Type Code : Individual
Provider Name (Legal Business Name) : ISAIAH BENNETT
Provider Business Mailing Address
First Line : 219 HAMILTON AVE APT 3E
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10301-1638
Country : US
Telephone Number : 917-755-0596
Fax Number :
Provider Business Practice Location Address
First Line : 19 VEDDER AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-1509
Country : US
Telephone Number : 718-370-2975
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2017
Last Update Date : 07/07/2017

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Directions to “ ISAIAH BENNETT ” Practice Location

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