Provider Demographics
NPI:1427094408
Name:BENOVITZ, LARRY
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:BENOVITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 NE MIAMI GARDENS DR
Mailing Address - Street 2:# 403
Mailing Address - City:N MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4836
Mailing Address - Country:US
Mailing Address - Phone:305-957-1977
Mailing Address - Fax:305-957-8858
Practice Address - Street 1:1550 NE MIAMI GARDENS DR
Practice Address - Street 2:# 403
Practice Address - City:N MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4836
Practice Address - Country:US
Practice Address - Phone:305-957-1977
Practice Address - Fax:305-957-8858
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME331812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065039100Medicaid
FLD63537Medicare UPIN
FL95614Medicare PIN