Provider Demographics
NPI:1871266411
Name:JACLYN BENZONI OD PC
Entity Type:Organization
Organization Name:JACLYN BENZONI OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BENZONI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:516-546-3227
Mailing Address - Street 1:40 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3508
Mailing Address - Country:US
Mailing Address - Phone:631-587-2020
Mailing Address - Fax:
Practice Address - Street 1:40 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3508
Practice Address - Country:US
Practice Address - Phone:631-587-2020
Practice Address - Fax:631-587-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty