Provider Demographics
NPI:1821620279
Name:VALENZUELA, BENJAMIN CONSTANTINO JR (RN)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:CONSTANTINO
Last Name:VALENZUELA
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 EAST 125 ST
Mailing Address - Street 2:MEYER BUILDING
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-6000
Mailing Address - Country:US
Mailing Address - Phone:646-766-4471
Mailing Address - Fax:
Practice Address - Street 1:600 EAST 125 ST
Practice Address - Street 2:MEYER BUILDING
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-6000
Practice Address - Country:US
Practice Address - Phone:646-766-4471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY540577163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health