Provider Demographics
NPI:1023447646
Name:JEREMIAH BENOIT MD, PLLC
Entity type:Organization
Organization Name:JEREMIAH BENOIT MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENOIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-842-7161
Mailing Address - Street 1:5010 STATE HIGHWAY 30
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-7532
Mailing Address - Country:US
Mailing Address - Phone:518-842-7161
Mailing Address - Fax:518-842-0797
Practice Address - Street 1:5010 STATE HIGHWAY 30
Practice Address - Street 2:SUITE 201
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7532
Practice Address - Country:US
Practice Address - Phone:518-842-7161
Practice Address - Fax:518-842-0797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257382261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care