Basic Information
| Provider Information | |||||||||
| NPI: | 1760526149 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENSON | ||||||||
| FirstName: | QUINTINA | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 E TREMONT AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104602306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188428040 | ||||||||
| FaxNumber: | 7188428394 | ||||||||
| Practice Location | |||||||||
| Address1: | 2187 RICHMOND AVE | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103143920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466827364 | ||||||||
| FaxNumber: | 6466827399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2007 | ||||||||
| LastUpdateDate: | 09/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MA09571300 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 253914 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.