MEDICARE: JOSEPH BENEZRA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	127387	NY

General Provider Information

NPI Number	:	1508873878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH BENEZRA

Provider Business Mailing Address
First Line	:	1045 E 18TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 E 18TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4405
Country	:	US
Telephone Number	:	718-998-6939
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	10/25/2008

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Directions to “ JOSEPH BENEZRA ” Practice Location

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