Individual
MR. JERRY A, BENJAMIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1060 DAY HILL RD, WINDSOR, CT 06095-5719
(860) 683-2690
(860) 683-2670
Mailing address
1060 DAY HILL RD, WINDSOR, CT 06095-5719
(860) 696-2450
(860) 696-2460
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
000069
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316915259
NPI
CT
Enumeration date
03/08/2006
Last updated
12/19/2013
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