Provider Demographics
NPI:1427501261
Name:BENYARKO, ANTHONY (MS, L-ATC, CES)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:BENYARKO
Suffix:
Gender:M
Credentials:MS, L-ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 JUSTIN WAY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4617
Mailing Address - Country:US
Mailing Address - Phone:347-581-2442
Mailing Address - Fax:
Practice Address - Street 1:708 JUSTIN WAY
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4617
Practice Address - Country:US
Practice Address - Phone:347-581-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2023-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA00009382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer