Provider Demographics
NPI:1669702965
Name:PHILIP J BENYO, M.D., P.C.
Entity type:Organization
Organization Name:PHILIP J BENYO, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BENYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-788-6363
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:DRUMS
Mailing Address - State:PA
Mailing Address - Zip Code:18222-0395
Mailing Address - Country:US
Mailing Address - Phone:570-788-6363
Mailing Address - Fax:
Practice Address - Street 1:144 S OLD TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:DRUMS
Practice Address - State:PA
Practice Address - Zip Code:18222-1720
Practice Address - Country:US
Practice Address - Phone:570-788-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA-051116363AM0700X
PAMD-022634-E207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty