Provider Demographics
NPI:1891679692
Name:MOKHTAR BENOUNNANE, MOHAMED (RN)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:MOKHTAR BENOUNNANE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 76TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3306
Mailing Address - Country:US
Mailing Address - Phone:646-549-7430
Mailing Address - Fax:
Practice Address - Street 1:545 76TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3306
Practice Address - Country:US
Practice Address - Phone:646-549-7430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF349642363LF0000X
NY740886163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily