Healthcare Provider Details

I. General information

NPI: 1164301578
Provider Name (Legal Business Name): BENINMED PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 GLADES RD STE 108
BOCA RATON FL
33434-3958
US

IV. Provider business mailing address

9250 GLADES RD STE 108
BOCA RATON FL
33434-3958
US

V. Phone/Fax

Practice location:
  • Phone: 561-463-8554
  • Fax: 561-983-6045
Mailing address:
  • Phone: 561-463-8554
  • Fax: 561-983-6045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW BENIN
Title or Position: CEO/MD
Credential: MD
Phone: 347-450-6191