Provider Demographics
NPI:1811980436
Name:BENKE, JOHN (PT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:BENKE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 3RD AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2167
Mailing Address - Country:US
Mailing Address - Phone:212-861-2630
Mailing Address - Fax:212-861-2685
Practice Address - Street 1:170 E 77TH ST
Practice Address - Street 2:SUITE #2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1912
Practice Address - Country:US
Practice Address - Phone:212-249-5332
Practice Address - Fax:212-249-9539
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQN2251OtherBLUE CROSS/BLUE SHIELD
NYQN2251OtherBLUE CROSS/BLUE SHIELD