Provider Demographics
NPI:1780292433
Name:GAMACHE, BENJAMIN LEO (DC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LEO
Last Name:GAMACHE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HUCKLEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1801
Mailing Address - Country:US
Mailing Address - Phone:413-663-0253
Mailing Address - Fax:
Practice Address - Street 1:301 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4900
Practice Address - Country:US
Practice Address - Phone:631-543-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor