MEDICARE: JONATHAN WAYNE BENJAMIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	144781	NY

General Provider Information

NPI Number	:	1558332072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN WAYNE BENJAMIN M.D.

Provider Business Mailing Address
First Line	:	2185 WANTAGH AVE
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-3917
Country	:	US
Telephone Number	:	516-785-3900
Fax Number	:	516-783-0033

Provider Business Practice Location Address
First Line	:	2185 WANTAGH AVE
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-3917
Country	:	US
Telephone Number	:	516-785-3900
Fax Number	:	516-783-0033

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	06/05/2008

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