Provider Demographics
NPI:1851551527
Name:BENITEZ, MARCO A (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:A
Last Name:BENITEZ
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3875
Mailing Address - Country:US
Mailing Address - Phone:718-535-7927
Mailing Address - Fax:347-527-2988
Practice Address - Street 1:3029 38TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3875
Practice Address - Country:US
Practice Address - Phone:718-535-7927
Practice Address - Fax:347-527-2988
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011954363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH39510Medicare UPIN