Benjamin Defazio

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

304 Pennsylvania Ave
Nutter Fort, WV 26301-4520

Phone

(304) 933-3073

NPI assigned

Sep 7, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1410048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410048000000",
    "number": "1124429337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 PENNSYLVANIA AVE",
            "city": "NUTTER FORT",
            "state": "WV",
            "postal_code": "263014520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 PENNSYLVANIA AVE",
            "city": "NUTTER FORT",
            "state": "WV",
            "postal_code": "263014520",
            "telephone_number": "304-933-3073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEFAZIO",
        "first_name": "BENJAMIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-09-07",
        "last_updated": "2014-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Community Care of West Virginia, Inc.
• Community Care of West Virginia, Inc.
• Travis Allen Cottrill, RN
• Holly Crayton
• John Byrnside Davis, DDS
• Dr. Robert Martino, PLLC
• Krystal Elias
• Melissa Renae Eubank
• First Settlement Physical Therapy
• Jerry Blaine Forinash Jr., M.P.T.

• All providers in Nutter Fort, WV
• Speech-Language Pathologist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.