Provider Demographics
NPI:1043388424
Name:BENJAMIN, EMMA (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMA
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6411 99TH ST
Mailing Address - Street 2:#604
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2654
Mailing Address - Country:US
Mailing Address - Phone:718-275-5811
Mailing Address - Fax:360-237-7854
Practice Address - Street 1:7802 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3530
Practice Address - Country:US
Practice Address - Phone:718-968-8484
Practice Address - Fax:718-241-3992
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209190208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01898420Medicaid
NYG84343Medicare UPIN
NY01898420Medicaid