Provider Demographics
NPI:1659747723
Name:TAYLOR, BEN
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-4911
Mailing Address - Country:US
Mailing Address - Phone:203-853-4771
Mailing Address - Fax:203-853-4772
Practice Address - Street 1:365 WESTPORT AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4344
Practice Address - Country:US
Practice Address - Phone:203-853-4771
Practice Address - Fax:203-853-4772
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT406237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1598891855Medicaid