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NPI Code Detail

MEDICARE: LOLA BENNETT

MEDICARE: LOLA 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
1163W00000XRegistered Nurse405828-1NY
2163W00000XRegistered Nurse174625GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1405828-1OTHERNYREGISTERED NURSE
2174625OTHERGAREGISTERED NURSE

General Provider Information

NPI Number : 1316353238
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOLA BENNETT
Provider Business Mailing Address
First Line : 1115 CROES AVE
Second Line : B2
City : BRONX
State : NY
Zip : 10472-4533
Country : US
Telephone Number : 917-548-7532
Fax Number : 718-904-8320
Provider Business Practice Location Address
First Line : 1000 PELHAM PKWY S
Second Line : LTHHCP
City : BRONX
State : NY
Zip : 10461-1003
Country : US
Telephone Number : 718-409-7992
Fax Number : 718-904-8320
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2014
Last Update Date : 07/11/2014

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Directions to “ LOLA BENNETT ” Practice Location

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