Healthcare Provider Details

I. General information

NPI: 1063851483
Provider Name (Legal Business Name): RAQUEL BENCHOAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE DEPT INTERNAL MEDICINE MILLS 3RD FL
BRONX NY
10457-2545
US

IV. Provider business mailing address

4422 3RD AVE DEPT INTERNAL MEDICINE MILLS 3RD FL
BRONX NY
10457-2545
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-6202
  • Fax: 718-960-3486
Mailing address:
  • Phone: 718-960-6202
  • Fax: 718-960-3486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number291813
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: