Provider Demographics
NPI:1033466982
Name:BENELYAHOU, REBECCA ADRIAN (MA)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:ADRIAN
Last Name:BENELYAHOU
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 POLO RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1028
Mailing Address - Country:US
Mailing Address - Phone:516-967-1981
Mailing Address - Fax:
Practice Address - Street 1:72 POLO RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1028
Practice Address - Country:US
Practice Address - Phone:516-967-1981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCFY006684-1390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program