Provider Demographics
NPI:1497547723
Name:BENJAMIN-MOSLEY, LISAMARIE (RN)
Entity type:Individual
Prefix:
First Name:LISAMARIE
Middle Name:
Last Name:BENJAMIN-MOSLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 TOPSIDE LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2826
Mailing Address - Country:US
Mailing Address - Phone:347-351-1374
Mailing Address - Fax:347-351-1374
Practice Address - Street 1:82 TOPSIDE LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2826
Practice Address - Country:US
Practice Address - Phone:347-351-1374
Practice Address - Fax:347-351-1374
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY612485163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management