Provider Demographics
NPI:1376312264
Name:BENJAMIN, LIESEL D (MSN WHNP)
Entity Type:Individual
Prefix:
First Name:LIESEL
Middle Name:D
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MSN WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 CERENZIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3627
Mailing Address - Country:US
Mailing Address - Phone:585-309-8708
Mailing Address - Fax:
Practice Address - Street 1:87 CERENZIA BLVD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3627
Practice Address - Country:US
Practice Address - Phone:585-309-8708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY656781-01163WW0101X
NYF421563-01363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory