Provider Demographics
NPI:1669832283
Name:LEARY, BENJAMIN EDWARD (ATC)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:EDWARD
Last Name:LEARY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 HOWARD RD
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10996-1510
Mailing Address - Country:US
Mailing Address - Phone:845-938-8014
Mailing Address - Fax:
Practice Address - Street 1:639 HOWARD RD
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NY
Practice Address - Zip Code:10996-1510
Practice Address - Country:US
Practice Address - Phone:845-938-8014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0022202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer