1922003110 NPI number — DR. ISAAC BENZAQUEN PH.D.

Table of content: DR. ISAAC BENZAQUEN PH.D. (NPI 1922003110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922003110 NPI number — DR. ISAAC BENZAQUEN PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENZAQUEN
Provider First Name:
ISAAC
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922003110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3229 PERRY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11572-4233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-764-2243
Provider Business Mailing Address Fax Number:
516-764-7833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
143 MAPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDARHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11516-2225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-295-4104
Provider Business Practice Location Address Fax Number:
516-764-7833
Provider Enumeration Date:
06/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  90971 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 36684 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6153651 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4478353 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0003042 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01034311 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62308 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AS313 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P3842482 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 190033 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0190373 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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