Provider Demographics
NPI:1710136858
Name:BENONS, DAMIAN ANTHONY (PT)
Entity Type:Individual
Prefix:MR
First Name:DAMIAN
Middle Name:ANTHONY
Last Name:BENONS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23847 117TH RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4012
Mailing Address - Country:US
Mailing Address - Phone:516-729-8041
Mailing Address - Fax:
Practice Address - Street 1:23847 117TH RD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4012
Practice Address - Country:US
Practice Address - Phone:516-729-8041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-13
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ24Y01Medicare PIN