Provider Demographics
NPI:1730106519
Name:BENAVIV-MESKIN, DANIELLE P (MD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:P
Last Name:BENAVIV-MESKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 QUARRY RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4816
Mailing Address - Country:US
Mailing Address - Phone:203-374-6162
Mailing Address - Fax:203-371-7066
Practice Address - Street 1:112 QUARRY RD
Practice Address - Street 2:SUITE 250
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4816
Practice Address - Country:US
Practice Address - Phone:203-374-6162
Practice Address - Fax:203-371-7066
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044067207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001440677Medicaid