Provider Demographics
NPI:1780464693
Name:BENJAMIN, ROSE ASTRID
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:ASTRID
Last Name:BENJAMIN
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 1:681 CLARKSON AVE BLDG 19
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2199
Mailing Address - Country:US
Mailing Address - Phone:718-221-7479
Mailing Address - Fax:
Practice Address - Street 1:681 CLARKSON AVE BLDG 19
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2199
Practice Address - Country:US
Practice Address - Phone:718-221-7479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY443331163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty