Individual
MR. RICHARD OLIVER BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPA-C
Contact information
Practice address
2 ELLIS CT, CORAM, NY 11727-1473
(917) 837-8213
Mailing address
1745 UNION BLVD, BAY SHORE, NY 11706-7952
(631) 328-5560
(631) 328-5559
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
23-014569
NY
Other
Enumeration date
01/16/2011
Last updated
05/24/2017
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