Provider Demographics
NPI:1962626606
Name:BENENSON, TANYA (MD)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:BENENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ROCKEFELLER PLZ
Mailing Address - Street 2:RM 750S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10112-0002
Mailing Address - Country:US
Mailing Address - Phone:212-664-6943
Mailing Address - Fax:
Practice Address - Street 1:30 ROCKEFELLER PLZ
Practice Address - Street 2:RM 750S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10112-0002
Practice Address - Country:US
Practice Address - Phone:212-664-6943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH47113Medicare UPIN