Provider Demographics
NPI:1043047319
Name:MUSHEYEV, BENJAMIN MOSHE
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MOSHE
Last Name:MUSHEYEV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7019 175TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3416
Mailing Address - Country:US
Mailing Address - Phone:718-374-1126
Mailing Address - Fax:
Practice Address - Street 1:10022 67TH AVE
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4515
Practice Address - Country:US
Practice Address - Phone:718-440-9033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist