| Organization Name: | MATTHEW A. BENNETT MD PLLC |
| NPI Number: | 1114168408 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MATTHEW ANTHONY BENNETT (OWNER) |
| Mailing Address: | 624 River Rd Suite #1 North Tonawanda |
| State: | NY US |
| Postal Code: | 141206563 |
| Phone Number: | 7163322300 |
| Fax Number: | 7163322280 |
| NPI Enumeration Date: | 03/16/2009 |
| NPI Last Update Date: | 03/16/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 250570 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |