Provider Demographics
NPI:1487946372
Name:BENITEZ, ERIK
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:BENITEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ERIK
Other - Middle Name:
Other - Last Name:BENITEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:100 STATE ST APT 14
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2212
Mailing Address - Country:US
Mailing Address - Phone:615-336-5436
Mailing Address - Fax:
Practice Address - Street 1:972 W MAIN ST
Practice Address - Street 2:CONCENTRA URGENT CARE
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-3487
Practice Address - Country:US
Practice Address - Phone:860-827-0745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT53822208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery