Individual
DR. BRENDA A BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
470 LENOX AVENUE, SUITE #1P, NY, NY 10037
(212) 491-9200
(212) 690-3790
Mailing address
425 CONVENT AVE, NY, NY 10031
(212) 491-9890
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
139844
NY
207R00000X
Internal Medicine Physician
39842
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0022014
GHI
NY
05
—
00743568
—
NY
Enumeration date
12/13/2006
Last updated
07/08/2007
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