Provider Demographics
NPI:1871586354
Name:BENNETT, STANFORD (MD)
Entity type:Individual
Prefix:
First Name:STANFORD
Middle Name:
Last Name:BENNETT
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 1:1838 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4400
Mailing Address - Country:US
Mailing Address - Phone:914-962-3500
Mailing Address - Fax:914-245-7875
Practice Address - Street 1:1838 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4400
Practice Address - Country:US
Practice Address - Phone:914-962-3500
Practice Address - Fax:914-245-7875
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5390584207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10102747OtherCDPHP
GHI -PPOOther2589257
000000093159OtherGHI-HMO
5294204OtherCIGNA PROVIDER ID
129SD1OtherEMPIRE BC-BS
2545905OtherUNITED HEALTHCARE
1092475OtherAETNA-HMO
3C5202OtherHEALTHNET-GROUP PIN
7530743OtherAETNA-PPO
050922000003OtherFIDELIS CARE OF NY
388166OtherMVP HEALTHPLAN
P3609126OtherOXFORD HEALTH PLAN
5294204OtherCIGNA PROVIDER ID
2545905OtherUNITED HEALTHCARE
GHI -PPOOther2589257
I34665Medicare UPIN