Individual
OTMAINE BENASSOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
669 CASTLETON AVE, STATEN ISLAND, NY 10301-2028
(718) 442-2225
(718) 442-2289
Mailing address
14350 HOOVER AVE APT 303, BRIARWOOD, NY 11435-2158
(347) 579-8495
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F402232-1
NY
Other
Enumeration date
10/18/2017
Last updated
10/18/2017
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