Provider Demographics
NPI:1518281328
Name:LESLIE BENNETT MDPC
Entity Type:Organization
Organization Name:LESLIE BENNETT MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-380-0411
Mailing Address - Street 1:13540 78TH DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3236
Mailing Address - Country:US
Mailing Address - Phone:718-380-0411
Mailing Address - Fax:718-380-1436
Practice Address - Street 1:13540 78TH DR
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3236
Practice Address - Country:US
Practice Address - Phone:718-380-0411
Practice Address - Fax:718-380-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120795207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1487610556OtherNPI
NY00226724Medicaid
NYB79787Medicare UPIN
NY00226724Medicaid