Basic Information
| Provider Information | |||||||||
| NPI: | 1588690952 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TONNEAU | ||||||||
| FirstName: | BENOIT | ||||||||
| MiddleName: | ALBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 TROY SCHENECTADY RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187823700 | ||||||||
| FaxNumber: | 5187823799 | ||||||||
| Practice Location | |||||||||
| Address1: | 2546 BALLTOWN RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SCHENECTADY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 123091079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183741444 | ||||||||
| FaxNumber: | 5183740491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 01/31/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 214326 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 11411 | 01 | NY | MVP | OTHER | 7968646 | 01 | NY | AETNA | OTHER | 000492899001 | 01 | NY | BSNENY | OTHER | 200196 | 01 | NY | SENIOR WHOLE HELATH | OTHER | 02047634 | 05 | NY | MEDICAID | 050323000046 | 01 | NY | FIDELIS | OTHER | 10031103 | 01 | NY | CDPHP | OTHER | 47364 | 01 | NY | GHI/HMO | OTHER | 59N841 | 01 | NY | EMPIRE BC | OTHER |