Provider Demographics
NPI:1649265745
Name:BENJAMIN, YUKHANAN (MD)
Entity type:Individual
Prefix:
First Name:YUKHANAN
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 E HALLANDALE BEACH BLVD STE 404
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3772
Mailing Address - Country:US
Mailing Address - Phone:786-288-3661
Mailing Address - Fax:305-949-7479
Practice Address - Street 1:2100 E HALLANDALE BEACH BLVD STE 404
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3772
Practice Address - Country:US
Practice Address - Phone:786-288-3661
Practice Address - Fax:877-558-5721
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47946208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34062Medicare ID - Type UnspecifiedPHYSICIAN