Provider Demographics
NPI:1407248420
Name:BENNETT, BABETTE
Entity Type:Individual
Prefix:MRS
First Name:BABETTE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5705 ROUTE 96
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:NY
Mailing Address - Zip Code:14541-9551
Mailing Address - Country:US
Mailing Address - Phone:866-810-0345
Mailing Address - Fax:607-869-2121
Practice Address - Street 1:5705 ROUTE 96
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:NY
Practice Address - Zip Code:14541-9551
Practice Address - Country:US
Practice Address - Phone:866-810-0345
Practice Address - Fax:607-869-2121
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY423556-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY163W00000XMedicaid