1932165628 NPI number — ANTHONY P BENJAMIN MD

Table of content: ANTHONY P BENJAMIN MD (NPI 1932165628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932165628 NPI number — ANTHONY P BENJAMIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENJAMIN
Provider First Name:
ANTHONY
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932165628
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14890
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12212-4890
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-525-5634
Provider Business Mailing Address Fax Number:
518-649-4094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2231 BURDETT AVE STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-272-1333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  229456 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1099291 . This is a "GHI PPO#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 71021424811 . This is a "MVP VENDOR #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02491927 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100783615671 . This is a "CDPHP GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00063770 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000076448 . This is a "GHI HMO #" identifier . This identifiers is of the category "OTHER".
  • Identifier: AB035R241 . This is a "DOWN MEDICARE" identifier . This identifiers is of the category "OTHER".




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