Provider Demographics
NPI:1740470459
Name:BENENSTEIN, RICARDO J (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:J
Last Name:BENENSTEIN
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 1:29 HOSPITAL PLZ STE 502
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3602
Mailing Address - Country:US
Mailing Address - Phone:203-348-7410
Mailing Address - Fax:203-961-8488
Practice Address - Street 1:29 HOSPITAL PLZ STE 502
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3602
Practice Address - Country:US
Practice Address - Phone:203-348-7410
Practice Address - Fax:203-961-8488
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-29
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT69384207RC0000X
NY254009207RC0000X, 207RC0000X
FL133801207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279777100Medicaid
FL133801OtherFL MEDICAL LICENSE
NY254009OtherNY MEDICAL LICENSE
FLAH156ZMedicare PIN