Individual
DR. BENJAMIN ELIE FOMBONNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 NICOLLS RD RM 50, STONY BROOK, NY 11794-0001
(631) 444-2499
(631) 444-3919
Mailing address
103 WHITTIER PL, PORT JEFFERSON, NY 11777-1619
(202) 549-8587
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
314533
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/21/2019
Last updated
06/15/2022
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