Provider Demographics
NPI:1861575136
Name:BENHURI, MASSOUD (MD FACP)
Entity type:Individual
Prefix:
First Name:MASSOUD
Middle Name:
Last Name:BENHURI
Suffix:
Gender:M
Credentials:MD FACP
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:BENHURI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PC
Mailing Address - Street 1:161 STATION RD
Mailing Address - Street 2:
Mailing Address - City:KINGS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11024
Mailing Address - Country:US
Mailing Address - Phone:516-773-4178
Mailing Address - Fax:516-249-2240
Practice Address - Street 1:1025 N BROADWAY
Practice Address - Street 2:
Practice Address - City:NORTH MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758
Practice Address - Country:US
Practice Address - Phone:516-224-9313
Practice Address - Fax:516-249-2240
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175748207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01096657Medicaid
NY01096657Medicaid
E48997Medicare UPIN