Provider Demographics
NPI:1265742720
Name:BENZAQUEN, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BENZAQUEN
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 1:909 CHANNING RD
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4730
Mailing Address - Country:US
Mailing Address - Phone:718-868-0314
Mailing Address - Fax:
Practice Address - Street 1:445 CENTRAL AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2001
Practice Address - Country:US
Practice Address - Phone:516-374-3377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016323-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist