1235321860 NPI number — MR. CHRISTOPHER LAVERNE BENSON, LLC L.MT.

Table of content: MR. CHRISTOPHER LAVERNE BENSON, LLC L.MT. (NPI 1235321860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235321860 NPI number — MR. CHRISTOPHER LAVERNE BENSON, LLC L.MT.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENSON, LLC
Provider First Name:
CHRISTOPHER
Provider Middle Name:
LAVERNE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
L.MT.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235321860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 RENDE PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14450-4515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-755-7246
Provider Business Mailing Address Fax Number:
888-266-4849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 MERRICK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRICK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11566-2718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-266-6666
Provider Business Practice Location Address Fax Number:
888-266-4849
Provider Enumeration Date:
08/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  017265 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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