Provider Demographics
NPI:1720286297
Name:BENJAMIN, ALIX
Entity Type:Individual
Prefix:
First Name:ALIX
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 OCEAN AVE
Mailing Address - Street 2:APT 6K
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:163 OCEAN AVE
Practice Address - Street 2:APT 6K
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-4736
Practice Address - Country:US
Practice Address - Phone:718-282-8106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant