Provider Demographics
NPI:1780949776
Name:BENJAMIN, CHARLENE (NP)
Entity type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 E MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2807
Mailing Address - Country:US
Mailing Address - Phone:631-724-4664
Mailing Address - Fax:
Practice Address - Street 1:257 E MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2807
Practice Address - Country:US
Practice Address - Phone:631-724-4664
Practice Address - Fax:631-360-7880
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3055181363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health