Individual
MICAH BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1372 ROUTE 44, BUILDING #2, PLEASANT VALLEY, NY 12569-7811
(845) 518-4827
(845) 691-6081
Mailing address
1372 ROUTE 44, BUILDING #2, PLEASANT VALLEY, NY 12569-7811
(845) 518-4827
(845) 691-6081
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
992089481
NY
Other
Enumeration date
05/26/2015
Last updated
05/26/2015
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