Basic Information
| Provider Information | |||||||||
| NPI: | 1003024936 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENAKNIN | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | ELI | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 307 S FRONT ST | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171041621 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 S FRONT ST | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171012010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177825908 | ||||||||
| FaxNumber: | 7177825716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 06/30/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | OS014188 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 244925 | 01 | UNISON | OTHER | 1020762700002 | 05 | PA | MEDICAID | 1572181 | 01 | GATEWAY | OTHER | 2061044 | 01 | HIGHMARK BLUE SHIELD | OTHER | 1020762700003 | 05 | PA | MEDICAID |