Provider Demographics
NPI:1710405477
Name:BENNETT, JEAN E
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:E
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 CARPENTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1420
Mailing Address - Country:US
Mailing Address - Phone:718-324-1262
Mailing Address - Fax:718-325-2259
Practice Address - Street 1:663 E 243RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1054
Practice Address - Country:US
Practice Address - Phone:718-519-8731
Practice Address - Fax:718-519-8731
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221118-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool