Healthcare Provider Details

I. General information

NPI: 1376040725
Provider Name (Legal Business Name): KESSIENA GBENEDIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

300 LAGUNA HONDA BLVD APT 107
SAN FRANCISCO CA
94116-1479
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-0892
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA11582300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: