21St Century Medical Plaza PC
Organization Active NPI Family Medicine Physician · Rego Park, NY
NPI 1760627582 · NPPES record last updated Dec 8, 2008
Key facts
- NPI
- 1760627582
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 240556 (NY)
- Legal business name
- 21ST CENTURY MEDICAL PLAZA PC
- Practice address
- 8716 63Rd Dr
Rego Park, NY 11374-4826 - Phone
- (917) 400-2530
- NPI assigned
- Dec 8, 2008
- Organization subpart
- No
Authorized official
- Name
- Irina Benyaminova, D.O.
- Title
- President
- Phone
- (917) 400-2530
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 240556 | NY | Yes |
Addresses
Primary practice location
8716 63Rd Dr
Rego Park, NY 11374-4826
Mailing address
8716 63Rd Dr
Rego Park, NY 11374-4826
Other providers in Rego Park, NY
- 1957 Bronx Medical P.C.
- 63Rd Drive Pharmacy Corp
- 63Rd RX Corp.
- 99-24 65Rd
- A & E Hearing Aid Center
- A B Speech LLC
All providers in Rego Park, NY · Family Medicine Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 8, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.