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General NPI Number Information
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NPI Number | 1366948499
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Entity Type | Individual
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Provider Name | BENITA BENJAMIN DO
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Gender | Female
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 10 MEDICAL PLZ
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City | GLEN COVE
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State | NY
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Zip | 11542-2101
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Country | US
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Telephone | 516-679-0239
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Fax |
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Provider Business Mailing Address
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Address Line | 10 MEDICAL PLZ
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City | GLEN COVE
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State | NY
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Zip | 11542-2101
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Country | US
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Telephone | 516-676-0239
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 309326
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License Number State | NY
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