Healthcare Provider Details

I. General information

NPI: 1043745334
Provider Name (Legal Business Name): BENJAMIN SCHNAKENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NMRTCPH 480 CENTRAL AVENUE
JOINT BASE PEARL HARBOR HICKAM HI
96860-4908
US

IV. Provider business mailing address

NAVY MEDICINE READINESS AND TRAINING COMMAND PEARL HARB 480 CENTRAL AVENUE
JOINT BASE PEARL HARBOR HICKAM HI
96860-4908
US

V. Phone/Fax

Practice location:
  • Phone: 518-788-2574
  • Fax:
Mailing address:
  • Phone: 808-473-1880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD-21256
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-21256
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: