Provider Demographics
NPI:1154667871
Name:BENCIK, JAMES (RN, CRRN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BENCIK
Suffix:
Gender:M
Credentials:RN, CRRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4746 44TH ST APT 3R
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-6329
Mailing Address - Country:US
Mailing Address - Phone:313-402-4709
Mailing Address - Fax:
Practice Address - Street 1:4746 44TH ST APT 3R
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-6329
Practice Address - Country:US
Practice Address - Phone:313-402-4709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY543889-1163W00000X, 163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation