Provider Demographics
NPI:1376640052
Name:BENYAMINOVA, NINA (MD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:BENYAMINOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10521 62ND DR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1133
Mailing Address - Country:US
Mailing Address - Phone:718-592-2502
Mailing Address - Fax:
Practice Address - Street 1:1302 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1960
Practice Address - Country:US
Practice Address - Phone:718-645-7020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238338174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist