Healthcare Provider Details

I. General information

NPI: 1730533068
Provider Name (Legal Business Name): BENITO ANTONIO FLORES OT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 04/03/2021
Certification Date: 04/03/2021
Deactivation Date: 07/20/2019
Reactivation Date: 04/03/2021

III. Provider practice location address

778 MORRIS PARK AVE
BRONX NY
10462-3652
US

IV. Provider business mailing address

778 MORRIS PARK AVE # 38
BRONX NY
10462-3652
US

V. Phone/Fax

Practice location:
  • Phone: 800-678-8605
  • Fax:
Mailing address:
  • Phone: 800-678-8605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number011795-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number011795-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number011795-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number011795-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: