Provider Demographics
NPI:1043301575
Name:BENNETT, AIDA V (MD)
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:V
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:450 W 33RD ST
Mailing Address - Street 2:PBS 12 TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2603
Mailing Address - Country:US
Mailing Address - Phone:212-356-4474
Mailing Address - Fax:212-356-4608
Practice Address - Street 1:355 BARD AVE
Practice Address - Street 2:MEDICINE
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1664
Practice Address - Country:US
Practice Address - Phone:718-818-4570
Practice Address - Fax:718-818-3740
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY187726207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F19415Medicare UPIN