Basic Information
| Provider Information | |||||||||
| NPI: | 1689797888 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENN | ||||||||
| FirstName: | JOANN | ||||||||
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| Credential: | RN, MS, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 S BEDFORD RD | ||||||||
| Address2: | CARE MOUNT MEDICAL PC | ||||||||
| City: | YORKTOWN HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105983211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142450918 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 E. MAIN STREET | ||||||||
| Address2: | CANCER CENTER | ||||||||
| City: | MT KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142411050 | ||||||||
| FaxNumber: | 9142421516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 11/14/2016 | ||||||||
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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 | 163WX0200X | 500576 | NY | N | Nursing Service Providers | Registered Nurse | Oncology | 363LF0000X | 333577 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 02458120 | 05 | NY | MEDICAID |