Healthcare Provider Details

I. General information

NPI: 1942871603
Provider Name (Legal Business Name): ROSITA CAROL BENJAMIN APRN,FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 07/05/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 N MAIN ST
NEW SQUARE NY
10977-8916
US

IV. Provider business mailing address

91 ROCKLAND LN
SPRING VALLEY NY
10977-2311
US

V. Phone/Fax

Practice location:
  • Phone: 845-354-9300
  • Fax:
Mailing address:
  • Phone: 845-826-6918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346986
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number346986
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: