Provider Demographics
NPI:1518258961
Name:BENJAMIN, LINDA THERESA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:THERESA
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PALMA CIR
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-1639
Mailing Address - Country:US
Mailing Address - Phone:203-574-2263
Mailing Address - Fax:
Practice Address - Street 1:1ST AVE &16 STREET
Practice Address - Street 2:BERNSTEIN BLDG
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-420-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003177363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical