MEDICARE: MISS ELIZABETH BENNETT LMT

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
1	225700000X	Massage Therapist	0236781	NY
2	225700000X	Massage Therapist	023678-1	NY

General Provider Information

NPI Number	:	1730544941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ELIZABETH BENNETT LMT

Provider Business Mailing Address
First Line	:	342 E 55TH ST APT 1A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-4149
Country	:	US
Telephone Number	:	347-266-5751
Fax Number	:

Provider Business Practice Location Address
First Line	:	342 E 55TH ST APT 1A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-4149
Country	:	US
Telephone Number	:	347-266-5751
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2015
Last Update Date	:	11/24/2023

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