Provider Demographics
NPI:1144381989
Name:ANTHONY BENNARDO MD PC
Entity Type:Organization
Organization Name:ANTHONY BENNARDO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-765-2995
Mailing Address - Street 1:PO BOX 927
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-0927
Mailing Address - Country:US
Mailing Address - Phone:631-765-2995
Mailing Address - Fax:631-765-9533
Practice Address - Street 1:54075 MAIN ROAD
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-0927
Practice Address - Country:US
Practice Address - Phone:631-765-2995
Practice Address - Fax:631-765-9533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEZ511Medicare ID - Type Unspecified