Individual
DR. TRAVIS JAMES BENCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
HSC T16 080, STONY BROOK, NY 11794-8167
(631) 444-1060
(631) 444-1054
Mailing address
PO BOX 1554, STONY BROOK, NY 11790-0988
(631) 444-0650
(631) 638-4170
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
00245267
NY
207R00000X
Internal Medicine Physician
245267
NY
207RC0000X
Cardiovascular Disease Physician
Primary
245267
NY
363A00000X
Physician Assistant
006594
NY
390200000X
Student in an Organized Health Care Education/Training Program
245267
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03424935
—
NY
01
—
245267
NYS LICENSE
NY
Enumeration date
07/08/2006
Last updated
09/08/2016
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