# 21ST CENTURY MEDICAL PLAZA PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760627582
- **Authorized official:** IRINA BENYAMINOVA D.O. (PRESIDENT)
- **Authorized official phone:** (917) 400-2530

## Contact information

- **Practice address:** 8716 63RD DR, REGO PARK, NY 11374-4826
- **Practice address phone:** (917) 400-2530
- **Mailing address:** 8716 63RD DR, REGO PARK, NY 11374-4826

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 240556 | NY | Yes |

## Other

- **Enumeration date:** 12/08/2008
- **Last updated:** 12/08/2008