Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | NJ | |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 667PZ8832 | NY |
NPI | 1255479077 |
---|---|
Provider Name | Dr. Henry Benvenisti |
First Address | Montvale, NJ 07645 |
Second Address | Montvale, NJ 07645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 31/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0059327 | GHI OF NY (01) | NY |
103066 | VALUE OPTIONS OF NY (01) | NY |
HB699478 | (05) | NJ |
VZ6881 | BLUE CROSS (01) | NJ |