Provider Demographics
NPI:1275611220
Name:BENJAMIN, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1983 MARCUS AVE
Mailing Address - Street 2:SUITE E132
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1016
Mailing Address - Country:US
Mailing Address - Phone:516-216-1780
Mailing Address - Fax:516-706-0613
Practice Address - Street 1:1983 MARCUS AVE
Practice Address - Street 2:SUITE E132
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1016
Practice Address - Country:US
Practice Address - Phone:516-216-1780
Practice Address - Fax:516-706-0613
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1429382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C11189Medicare UPIN
55A011Medicare ID - Type Unspecified