Healthcare Provider Details

I. General information

NPI: 1003671850
Provider Name (Legal Business Name): BENITO JOSEPH JR. PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 BAY STREET 1ST & 3RD FLOOR
STATEN ISLAND NY
10301
US

IV. Provider business mailing address

2351 BEDFORD AVE FL 2
BROOKLYN NY
11226-5403
US

V. Phone/Fax

Practice location:
  • Phone: 844-400-1975
  • Fax:
Mailing address:
  • Phone: 844-400-1975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15328900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number682961
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF406352-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: