Provider Demographics
NPI:1104364058
Name:BENJAMIN, BINCY (OD)
Entity Type:Individual
Prefix:DR
First Name:BINCY
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:BINCY
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:88 MARCUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3423
Mailing Address - Country:US
Mailing Address - Phone:516-967-7110
Mailing Address - Fax:
Practice Address - Street 1:971 MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1609
Practice Address - Country:US
Practice Address - Phone:631-471-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008542152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist