Provider Demographics
NPI:1821085341
Name:BENINCASA, LAURA M (RPH)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:M
Last Name:BENINCASA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3201
Mailing Address - Country:US
Mailing Address - Phone:516-489-2940
Mailing Address - Fax:
Practice Address - Street 1:107 MEACHAM AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2630
Practice Address - Country:US
Practice Address - Phone:516-354-2950
Practice Address - Fax:516-354-3375
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist