Provider Demographics
NPI:1962829358
Name:BENJAMIN, TAINA MARCELLE (LPN)
Entity Type:Individual
Prefix:MS
First Name:TAINA
Middle Name:MARCELLE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PHYLLIS DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2629
Mailing Address - Country:US
Mailing Address - Phone:845-548-6731
Mailing Address - Fax:845-354-8535
Practice Address - Street 1:5 PHYLLIS DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-2629
Practice Address - Country:US
Practice Address - Phone:845-548-6731
Practice Address - Fax:845-354-8535
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311407-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse