Provider Demographics
NPI:1316527823
Name:ST.MARTIN, BENJAMIN (MS, LAT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:ST.MARTIN
Suffix:
Gender:M
Credentials:MS, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4711
Mailing Address - Country:US
Mailing Address - Phone:860-508-6332
Mailing Address - Fax:
Practice Address - Street 1:5151 PARK AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-1000
Practice Address - Country:US
Practice Address - Phone:203-396-8179
Practice Address - Fax:203-365-4704
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer