Provider Demographics
NPI:1003024936
Name:BENAKNIN, JOSEPH ELI (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ELI
Last Name:BENAKNIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S FRONT ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 S FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2010
Practice Address - Country:US
Practice Address - Phone:717-782-5908
Practice Address - Fax:717-782-5716
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014188207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
244925OtherUNISON
PA1020762700002Medicaid
1572181OtherGATEWAY
2061044OtherHIGHMARK BLUE SHIELD
PA1020762700003Medicaid
PA1020762700002Medicaid
P00637103Medicare PIN