Provider Demographics
NPI:1538617790
Name:JACLYN BENZONI OD PC
Entity type:Organization
Organization Name:JACLYN BENZONI OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENZONI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:516-721-7003
Mailing Address - Street 1:2126 MERRICK MALL
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3626
Mailing Address - Country:US
Mailing Address - Phone:516-546-3227
Mailing Address - Fax:
Practice Address - Street 1:2126 MERRICK MALL
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3626
Practice Address - Country:US
Practice Address - Phone:516-546-3227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-16
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007403-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1205065935OtherNPPES