1164785473 NPI number — MRS. NICOLE ANN BENITEZ MASTERS

Table of content: MRS. NICOLE ANN BENITEZ MASTERS (NPI 1164785473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164785473 NPI number — MRS. NICOLE ANN BENITEZ MASTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENITEZ
Provider First Name:
NICOLE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MASTERS
Provider Gender Code:
F

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:
1164785473
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 RICHBELL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAMARONECK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10543-3273
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1234 NORTH AVE
Provider Second Line Business Practice Location Address:
THERACARE INC.
Provider Business Practice Location Address City Name:
NEW ROCHELLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-576-5292
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2012

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: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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