Provider Demographics
NPI:1871672410
Name:BENNER, MARIA (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:BENNER
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 FRANKLIN AVENUE
Mailing Address - Street 2:SUITE ML-6
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-663-3511
Mailing Address - Fax:516-663-4780
Practice Address - Street 1:1300 FRANKLIN AVENUE
Practice Address - Street 2:SUITE ML-6
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-663-3511
Practice Address - Fax:516-663-4780
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301914363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health