Provider Demographics
NPI:1912080151
Name:BENNETT-GUERRERO, ELLIOTT (MD)
Entity Type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:
Last Name:BENNETT-GUERRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0988
Mailing Address - Country:US
Mailing Address - Phone:631-444-2975
Mailing Address - Fax:631-444-2907
Practice Address - Street 1:STONY BROOK ANESTHESIOLOGY UFPC STONY
Practice Address - Street 2:HEALTH SCIENCE CENTER LEVEL 4, #060
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8480
Practice Address - Country:US
Practice Address - Phone:631-444-2975
Practice Address - Fax:631-444-2907
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95-00828207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89134W4Medicaid
NC2019664Medicare PIN
G41883Medicare UPIN