Healthcare Provider Details

I. General information

NPI: 1255569182
Provider Name (Legal Business Name): BENISSE LESTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 N ST SW #N301
WASHINGTON DC
20024-4605
US

IV. Provider business mailing address

560 N ST SW #N301
WASHINGTON DC
20024-4605
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-0423
  • Fax:
Mailing address:
  • Phone: 212-420-0423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number162772
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: