MEDICARE: NICOLE BENOIT-ROY

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	174400000X	Specialist	1898809	NY
2	174400000X	Specialist	854645

General Provider Information

NPI Number	:	1568875714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE BENOIT-ROY

Provider Business Mailing Address
First Line	:	369 NOSTRAND AVE APT 3R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-5739
Country	:	US
Telephone Number	:	347-742-5591
Fax Number	:

Provider Business Practice Location Address
First Line	:	369 NOSTRAND AVE APT 3R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-5739
Country	:	US
Telephone Number	:	347-742-5591
Fax Number	:

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

Provider Enumeration Date	:	06/05/2014
Last Update Date	:	06/05/2014

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Directions to “ NICOLE BENOIT-ROY ” Practice Location

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