Active NPI
Mark Bengough
- Licensed Practical Nurse
- Deansboro, NY
National Provider Identifier
1659706356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 7597567
- Practice address
- 2701 Route 12B
Deansboro, NY 13328 - Phone
- (315) 797-1115
- NPI assigned
- Sep 12, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 7597567 | NY | Primary |
Addresses
Primary practice location
2701 Route 12B
Deansboro, NY 13328
Mailing address
2701 Route 12B
Deansboro, NY 13328
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7597567 | NY | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378944000000",
"number": "1659706356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2701 ROUTE 12B",
"city": "DEANSBORO",
"state": "NY",
"postal_code": "13328"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2701 ROUTE 12B",
"city": "DEANSBORO",
"state": "NY",
"postal_code": "13328",
"telephone_number": "315-797-1115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENGOUGH",
"first_name": "MARK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-09-12",
"last_updated": "2013-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "7597567",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Deansboro, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.