Provider Demographics
NPI:1972749935
Name:BENEWAY, MALCOLM JAMES (ORTHOTIST)
Entity type:Individual
Prefix:MR
First Name:MALCOLM
Middle Name:JAMES
Last Name:BENEWAY
Suffix:
Gender:M
Credentials:ORTHOTIST
Other - Prefix:MR
Other - First Name:MALCOLM
Other - Middle Name:JAMES
Other - Last Name:BENEWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PEDORTHIST
Mailing Address - Street 1:800 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2716
Mailing Address - Country:US
Mailing Address - Phone:315-425-4659
Mailing Address - Fax:315-425-2923
Practice Address - Street 1:800 IRVING AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2716
Practice Address - Country:US
Practice Address - Phone:315-425-4659
Practice Address - Fax:315-425-2923
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter