Gennadiy Benyaminov, DDS
Individual provider Active NPI Dentist · Monsey, NY
NPI 1740264753 · NPPES record last updated Jun 12, 2019
Key facts
- NPI
- 1740264753
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 485791 (NY)
- Practice address
- 40 Robert Pitt Dr
Monsey, NY 10952-3333 - Phone
- (845) 352-6800
- Fax
- (845) 770-3847
- NPI assigned
- Dec 2, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150403000046 | NY | Order and Referring Only - Dentist |
5799002804 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 485791 | NY | MD | Dentist |
| 048579 | NY | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 485791 | NY | Yes |
Addresses
Primary practice location
40 Robert Pitt Dr
Monsey, NY 10952-3333
Mailing address
40 Oceana Dr W
#3-C
Brooklyn, NY 11935
Phone (718) 743-8012
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02129266 | Medicaid | NY |
Other providers in Monsey, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.