Provider Demographics
NPI:1922003110
Name:BENZAQUEN, ISAAC (PHD)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:
Last Name:BENZAQUEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3229 PERRY AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4233
Mailing Address - Country:US
Mailing Address - Phone:516-764-2243
Mailing Address - Fax:516-764-7833
Practice Address - Street 1:143 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2225
Practice Address - Country:US
Practice Address - Phone:516-295-4104
Practice Address - Fax:516-764-7833
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY90971103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY36684OtherUNITED BEHAVIORAL HEALTH
NY6153651OtherUNITED HEALTH CARE
NY4478353OtherAETNA
NY0003042OtherGHI
NY01034311Medicaid
NY62308OtherCIGNA
CTAS313OtherOXFORD HEALTH PLANS
CTP3842482OtherOXFORD
NY190033OtherELDERPLAN
NY0190373OtherGHI
NYV3086VW841Medicare PIN
CTP3842482OtherOXFORD
NY4478353OtherAETNA
NY01034311Medicaid