Provider Demographics
NPI:1942237300
Name:BENJAMIN-MCKIE, ANGELA GILLIAN (AUD, MSA)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:GILLIAN
Last Name:BENJAMIN-MCKIE
Suffix:
Gender:F
Credentials:AUD, MSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 WATCHUNG AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4316
Mailing Address - Country:US
Mailing Address - Phone:973-338-9146
Mailing Address - Fax:
Practice Address - Street 1:130 W KINGSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3904
Practice Address - Country:US
Practice Address - Phone:718-584-9000
Practice Address - Fax:718-741-4702
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2022-06-09
Deactivation Date:2022-02-18
Deactivation Code:
Reactivation Date:2022-06-09
Provider Licenses
StateLicense IDTaxonomies
NY001341-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist