Provider Demographics
NPI:1487610556
Name:BENNETT, LESLIE G (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:G
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 1:135-40 78TH DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3236
Mailing Address - Country:US
Mailing Address - Phone:718-380-0411
Mailing Address - Fax:718-380-1436
Practice Address - Street 1:135-40 78TH DR
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3236
Practice Address - Country:US
Practice Address - Phone:718-380-8500
Practice Address - Fax:718-380-1436
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120795207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY92000467OtherOXFORD
NY00226724Medicaid
NY190693OtherUNITED HEALTHCARE
NY00226724Medicaid
NY906253Medicare ID - Type UnspecifiedBCBS
NY190693OtherUNITED HEALTHCARE