MEDICARE: BENJAMIN KOSUBEVSKY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	91359	SC
2	207Q00000X	Family Medicine Physician	OS16964	FL

General Provider Information

NPI Number	:	1881250363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN KOSUBEVSKY DO

Provider Business Mailing Address
First Line	:	15742 91ST TER N
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33478-6925
Country	:	US
Telephone Number	:	732-861-4429
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 VILLAGE BLVD STE 210
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-1952
Country	:	US
Telephone Number	:	561-210-4033
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2019
Last Update Date	:	02/18/2026

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