Individual
MRS. ELIZABETH RATNAMALA BENJAMIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTIONER
Contact information
Practice address
3600 ROUTE 112, CORAM, NY 11727-4116
(631) 920-8500
(631) 920-8501
Mailing address
3600 ROUTE 112, CORAM, NY 11727-4116
(631) 920-8500
(631) 920-8501
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
F401255
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
F401255
NY
Other
Enumeration date
07/27/2010
Last updated
07/28/2010
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