Provider Demographics
NPI:1053684167
Name:BENJAMIN, ELIE JUNIOR LOUIS (LPN)
Entity Type:Individual
Prefix:
First Name:ELIE JUNIOR
Middle Name:LOUIS
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OFFICE CENTER DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3219
Mailing Address - Country:US
Mailing Address - Phone:267-513-1722
Mailing Address - Fax:267-513-1728
Practice Address - Street 1:500 OFFICE CENTER DR
Practice Address - Street 2:SUITE 400
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3219
Practice Address - Country:US
Practice Address - Phone:267-513-1722
Practice Address - Fax:267-513-1728
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN277283164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse