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Individual

DR. MATTHEW THOMAS BENNETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
52 HARRISON ST, 2ND FL, JOHNSON CITY, NY 13790-2120
(607) 748-7468
(607) 754-6130
Mailing address
33 LEWIS RD, 2ND FL, BINGHAMTON, NY 13905-1048
(607) 729-8156
(607) 729-3982

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
230023
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02655714
NY
01
385812
MVP
NY
Enumeration date
07/18/2006
Last updated
03/16/2017
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