Provider Demographics
NPI:1831319110
Name:BENTON, VERONICA (LPN)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:BENTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 METCALF AVE APT 6H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-2898
Mailing Address - Country:US
Mailing Address - Phone:347-259-4900
Mailing Address - Fax:
Practice Address - Street 1:1232 METCALF AVE APT 6H
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-2898
Practice Address - Country:US
Practice Address - Phone:347-259-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287149-1164W00000X
NY374700000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02857692Medicaid