Basic Information
| Provider Information | |||||||||
| NPI: | 1043301575 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | AIDA | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 W 33RD ST | ||||||||
| Address2: | PBS 12 TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100012603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123564474 | ||||||||
| FaxNumber: | 2123564608 | ||||||||
| Practice Location | |||||||||
| Address1: | 355 BARD AVE | ||||||||
| Address2: | MEDICINE | ||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103101664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188184570 | ||||||||
| FaxNumber: | 7188183740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 187726 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.