Provider Demographics
NPI:1528397809
Name:BENJAMIN, CILIANNE
Entity Type:Individual
Prefix:
First Name:CILIANNE
Middle Name:
Last Name:BENJAMIN
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 1:993 CARROLL ST
Mailing Address - Street 2:APT C7
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-1967
Mailing Address - Country:US
Mailing Address - Phone:718-774-6423
Mailing Address - Fax:
Practice Address - Street 1:993 CARROLL ST
Practice Address - Street 2:APT C7
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-1967
Practice Address - Country:US
Practice Address - Phone:718-774-6423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY622499163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse