Provider Demographics
NPI:1689746752
Name:BENNETT, GARRETT H (MD)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:H
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E 61ST ST
Mailing Address - Street 2:SUITE 7C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8183
Mailing Address - Country:US
Mailing Address - Phone:212-980-2600
Mailing Address - Fax:212-991-3009
Practice Address - Street 1:115 E 61ST ST
Practice Address - Street 2:SUITE 7C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8183
Practice Address - Country:US
Practice Address - Phone:212-980-2600
Practice Address - Fax:212-991-3009
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219211207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02656504Medicaid
NYI17392Medicare UPIN
NY0105VGMedicare ID - Type Unspecified