Provider Demographics
NPI:1598126260
Name:BENJAMIN, CHINONYE
Entity Type:Individual
Prefix:
First Name:CHINONYE
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 1:85-35 LEFFERT BLVD
Mailing Address - Street 2:KEW GARDENS
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415
Mailing Address - Country:US
Mailing Address - Phone:646-377-2121
Mailing Address - Fax:
Practice Address - Street 1:85-35 LEFFERT BLVD
Practice Address - Street 2:KEW GARDENS
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11415
Practice Address - Country:US
Practice Address - Phone:646-377-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304986164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY304986Medicaid