Provider Demographics
NPI:1659015048
Name:BENNION, SAMUEL (MS)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:BENNION
Suffix:
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:BENNION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:7000 POLK ST # 504
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7000 POLK ST # 504
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093-1825
Practice Address - Country:US
Practice Address - Phone:970-439-4733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty