Provider Demographics
NPI:1730122359
Name:BENARDOT PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:BENARDOT PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/BILLING SPECIALIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUIFFRIDA
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:518-483-5800
Mailing Address - Street 1:58 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953
Mailing Address - Country:US
Mailing Address - Phone:518-483-5800
Mailing Address - Fax:481-483-1113
Practice Address - Street 1:58 ELM ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1507
Practice Address - Country:US
Practice Address - Phone:518-483-5800
Practice Address - Fax:518-483-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229747174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02459965Medicaid