Provider Demographics
NPI:1134849375
Name:BENCKO, JULIA NOELLE
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:NOELLE
Last Name:BENCKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 TULIP AVE APT CB1
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1977
Mailing Address - Country:US
Mailing Address - Phone:440-591-9207
Mailing Address - Fax:
Practice Address - Street 1:2341 NEW HYDE PARK RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1212
Practice Address - Country:US
Practice Address - Phone:516-806-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1643429221174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist