Provider Demographics
NPI:1275594665
Name:BENARDOT, EMILE (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILE
Middle Name:
Last Name:BENARDOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 PARK ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1238
Mailing Address - Country:US
Mailing Address - Phone:518-483-5800
Mailing Address - Fax:518-483-1113
Practice Address - Street 1:183 PARK ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1238
Practice Address - Country:US
Practice Address - Phone:518-483-5800
Practice Address - Fax:518-483-1113
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229747208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02459965Medicaid
NY411858OtherMVP PROVIDER ID
NY02459965Medicaid