| Doctor Name: | MICAH BENNETT |
| NPI Number: | 1316326143 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 992089481 |
| Business Practice Address: | 1372 Route 44 Building #2 Pleasant Valley, NY - 125697811 |
| Business Phone Number: | 8455184827 |
| Business Fax Number: | 8456916081 |
| Mailing Address: | 1372 Route 44, Building #2 PLEASANT VALLEY |
| State: | NY |
| Postal Code: | 125697811 |
| Phone Number: | 8455184827 |
| Fax Number: | 8456916081 |
| NPI Enumeration Date: | 05/26/2015 |
| NPI Last Update Date: | 05/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 172A00000X |
| License Number: | 992089481 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Driver |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person employed to operate a motor vehicle as a carrier of persons or property. |