Provider Demographics
NPI:1679901367
Name:JOHNSON, BENAY (RN, MSN, NNP-BC)
Entity type:Individual
Prefix:MRS
First Name:BENAY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN, MSN, NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 GRAND CONCOURSE
Mailing Address - Street 2:OB/GYN
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457
Mailing Address - Country:US
Mailing Address - Phone:718-239-8389
Mailing Address - Fax:718-239-8660
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:OB/GYN
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7606
Practice Address - Country:US
Practice Address - Phone:718-239-8398
Practice Address - Fax:718-239-8660
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELM-0010189363LN0005X
NYF350352363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care