Look up the most recent NPI and PECOS records

Benjamin Elie Fombonne

Emergency Medicine

Allopathic & Osteopathic Physicians

101 Nicolls Rd Rm 50, Stony Brook, NY 11794-0001

PECOS Enrollment

This provider is enrolled in PECOS as BENJAMIN FOMBONNE.

Based on the most recent information from CMS, provider Benjamin Elie Fombonne is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1932669439
Provider Type
Individual
Full Name
Fombonne, Benjamin Elie
Title
Dr.
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
3/21/2019
Last Updated
6/15/2022

Contact Information

Practice Location

101 Nicolls Rd Rm 50, Stony Brook, NY 11794-0001

(631) 444-2499

(631) 444-3919

Mailing Location

103 Whittier Pl, Port Jefferson, NY 11777-1619

(202) 549-8587

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207P00000X Primary	Description Emergency Medicine Allopathic & Osteopathic Physicians	License 314533 New York
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Benjamin Elie Fombonne

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Polito, Christopher

Miller, Emily Kathleen Hogan

Conrad, Cara

Ulloa, Nicolas Alejandro

Weingart, Scott D.

Constantine, Matthew Wayne

Wright, Brian Joseph

Larson, Justin

Leung, Liza

Kallus, Lester