Provider Demographics
NPI:1306571971
Name:BENTIL, BENEDICTA KAKRA
Entity type:Individual
Prefix:
First Name:BENEDICTA
Middle Name:KAKRA
Last Name:BENTIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 COMMONWEALTH AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-4634
Mailing Address - Country:US
Mailing Address - Phone:347-449-9475
Mailing Address - Fax:
Practice Address - Street 1:1226 COMMONWEALTH AVE APT 1F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-4634
Practice Address - Country:US
Practice Address - Phone:347-449-9475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1550784211174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist