Provider Demographics
NPI:1083926828
Name:LARRY BENOVITZ, MD, PA
Entity Type:Organization
Organization Name:LARRY BENOVITZ, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-957-1977
Mailing Address - Street 1:1550 NE MIAMI GARDENS DR
Mailing Address - Street 2:SUITE 403
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4836
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1550 NE MIAMI GARDENS DR
Practice Address - Street 2:SUITE 403
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4836
Practice Address - Country:US
Practice Address - Phone:305-957-1977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00331812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065039100Medicaid
FL95614Medicare PIN
FLD63537Medicare UPIN