Provider Demographics
NPI:1295067825
Name:BEN ELOHIM
Entity type:Organization
Organization Name:BEN ELOHIM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-220-1414
Mailing Address - Street 1:PO BOX 8741
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-8741
Mailing Address - Country:US
Mailing Address - Phone:787-220-1414
Mailing Address - Fax:
Practice Address - Street 1:AVE MONSERRATE
Practice Address - Street 2:INSITE FARMACIA PUERTA DE CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5444
Practice Address - Country:US
Practice Address - Phone:787-220-1414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-07
Last Update Date:2010-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332H00000X332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR190715OtherCORPORATE ID #