Healthcare Provider Details

I. General information

NPI: 1740470459
Provider Name (Legal Business Name): RICARDO J BENENSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2007
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 HOSPITAL PLZ STE 502
STAMFORD CT
06902-3602
US

IV. Provider business mailing address

29 HOSPITAL PLZ STE 502
STAMFORD CT
06902-3602
US

V. Phone/Fax

Practice location:
  • Phone: 203-348-7410
  • Fax: 203-961-8488
Mailing address:
  • Phone: 203-348-7410
  • Fax: 203-961-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number69384
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number254009
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number133801
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: