Provider Demographics
NPI:1669127593
Name:BENENATI, GREGORY
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:BENENATI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BEATRICE CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5302
Mailing Address - Country:US
Mailing Address - Phone:631-827-7172
Mailing Address - Fax:
Practice Address - Street 1:3 BEATRICE CT
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5302
Practice Address - Country:US
Practice Address - Phone:631-827-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant