Provider Demographics
NPI:1497125033
Name:BENSON, EMILY JESSICA
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JESSICA
Last Name:BENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 ANDREWS AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-6001
Mailing Address - Country:US
Mailing Address - Phone:718-561-5300
Mailing Address - Fax:
Practice Address - Street 1:2336 ANDREWS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-6001
Practice Address - Country:US
Practice Address - Phone:718-561-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator