Jeffrey C Benezra

Key facts

NPI

1104835834

Entity type

Individual (NPI type 1)

Primary specialty

Psychiatry Physician 2084P0800X

License

116968 (NY)

Practice address

983 Park Avenue
Ste 1C
Nyc, NY 10028

Phone

(212) 772-6005

NPI assigned

Aug 5, 2006

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Opted out of Medicare

Yes, effective May 1, 2014 through May 1, 2028

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104835834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "983 PARK AVENUE",
            "address_2": "STE 1C",
            "city": "NYC",
            "state": "NY",
            "postal_code": "10028",
            "telephone_number": "212-772-6005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "983 PARK AVENUE",
            "address_2": "STE 1C",
            "city": "NYC",
            "state": "NY",
            "postal_code": "10028",
            "telephone_number": "212-772-6005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENEZRA",
        "first_name": "JEFFREY",
        "middle_name": "C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "116968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Nyc, NY · Psychiatry Physician in New York