Active NPI
Benzaquen Psychological Services, PLLC
- Clinical Psychologist
- Cedarhurst, NY
National Provider Identifier
1710079751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 9097-1
- Legal business name
- BENZAQUEN PSYCHOLOGICAL SERVICES, PLLC
- Practice address
- 143 Maple Ave
Cedarhurst, NY 11516-2225 - Phone
- (516) 295-4104
- Fax
- (516) 764-7833
- NPI assigned
- Sep 28, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Isaac Benzaquen, PHD
- Title
- Managing Member
- Phone
- (516) 295-4104
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 9097-1 | NY | Primary |
Addresses
Primary practice location
143 Maple Ave
Cedarhurst, NY 11516-2225
Mailing address
3229 Perry Ave
Oceanside, NY 11572-4233
Phone (516) 295-4104
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02870166 | Medicaid | NY |
Other names 1
- Benzaquen Psychological Services, PLLC
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070516000202 | NY | Part B Supplier - Clinic/Group Practice | 4688771298 |
Receives reassigned benefits from 5 practitioners Practice locations: Cedarhurst, NY; Far Rockaway, NY; Long Beach, NY |
National Provider Directory
National Provider DirectoryLocations
143 Maple Ave
Cedarhurst, NY 11516
Phone (516) 295-4104
1441 Gateway Blvd
Far Rockaway, NY 11691
Phone (718) 471-1500
Practitioners & affiliated clinicians
Practitioners 9
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1186704000000",
"number": "1710079751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3229 PERRY AVE",
"city": "OCEANSIDE",
"state": "NY",
"postal_code": "115724233",
"telephone_number": "516-295-4104",
"fax_number": "516-764-7833"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "143 MAPLE AVE",
"city": "CEDARHURST",
"state": "NY",
"postal_code": "115162225",
"telephone_number": "516-295-4104",
"fax_number": "516-764-7833"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BENZAQUEN PSYCHOLOGICAL SERVICES, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-28",
"last_updated": "2007-08-10",
"status": "A",
"authorized_official_last_name": "BENZAQUEN",
"authorized_official_first_name": "ISAAC",
"authorized_official_title_or_position": "MANAGING MEMBER",
"authorized_official_telephone_number": "516-295-4104",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PHD"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "9097-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02870166",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Benzaquen Psychological Services, PLLC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Cedarhurst, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.