Basic Information
| Provider Information | |||||||||
| NPI: | 1275287427 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENONS | ||||||||
| FirstName: | RENETTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25311 FRANCIS LEWIS BLVD | ||||||||
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| City: | ROSEDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114222627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016134844 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1275 YORK AVE | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100656007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126392000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2022 | ||||||||
| LastUpdateDate: | 02/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 348380 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.