Provider Demographics
NPI:1407943707
Name:BENANTI, PHILIP E (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:E
Last Name:BENANTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WILMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4032
Mailing Address - Country:US
Mailing Address - Phone:516-428-8029
Mailing Address - Fax:
Practice Address - Street 1:65 WILMINGTON DR
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4032
Practice Address - Country:US
Practice Address - Phone:516-428-8029
Practice Address - Fax:718-996-5338
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094093207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
275871Medicare ID - Type Unspecified
E14852Medicare UPIN