Provider Demographics
NPI:1679618680
Name:BENITEZ, NANCY LANG (MS,ED)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LANG
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:MS,ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MANORAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949
Mailing Address - Country:US
Mailing Address - Phone:631-786-5477
Mailing Address - Fax:
Practice Address - Street 1:24 MANORAGE RD
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-3318
Practice Address - Country:US
Practice Address - Phone:631-786-5477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist