Basic Information
| Provider Information | |||||||||
| NPI: | 1518363530 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BENZENBERG | ||||||||
| FirstName: | JULIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 MAYBROOK RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CAMPBELL HALL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109162743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456364344 | ||||||||
| FaxNumber: | 8456364355 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 HATFIELD LN | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109246766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456152222 | ||||||||
| FaxNumber: | 8456152224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2014 | ||||||||
| LastUpdateDate: | 11/18/2014 | ||||||||
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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 | 225100000X | 038454 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.