Provider Demographics
NPI:1952871519
Name:BENANI, REDA
Entity Type:Individual
Prefix:
First Name:REDA
Middle Name:
Last Name:BENANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MUSTAPHA
Other - Middle Name:
Other - Last Name:ELBOUANANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7426 WOODSIDE AVE APT 3R
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1835
Mailing Address - Country:US
Mailing Address - Phone:347-355-5321
Mailing Address - Fax:
Practice Address - Street 1:7426 WOODSIDE AVE
Practice Address - Street 2:APT 3R
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1137
Practice Address - Country:US
Practice Address - Phone:347-355-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant