Provider Demographics
NPI:1720017056
Name:BENSON, JAY B (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:B
Last Name:BENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:546 CROMWELL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1800
Mailing Address - Country:US
Mailing Address - Phone:860-757-3874
Mailing Address - Fax:860-757-3875
Practice Address - Street 1:546 CROMWELL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1800
Practice Address - Country:US
Practice Address - Phone:860-757-3874
Practice Address - Fax:860-757-3875
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT01870207QA0401X
CT018720207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD300077904Medicare PIN
CT001187202Medicaid