Healthcare Provider Details

I. General information

NPI: 1720297732
Provider Name (Legal Business Name): RUBY BENJAMIN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 FRANKLIN AVE
VALLEY STREAM NY
11580-2145
US

IV. Provider business mailing address

8119 248TH ST
BELLEROSE NY
11426-1718
US

V. Phone/Fax

Practice location:
  • Phone: 516-256-6000
  • Fax: 516-256-6085
Mailing address:
  • Phone: 718-470-6396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number303294
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: