Healthcare Provider Details

I. General information

NPI: 1588128391
Provider Name (Legal Business Name): BENJAMIN GUSTAV FELDMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 CORDAGE PARK CIR STE 305
PLYMOUTH MA
02360-7332
US

IV. Provider business mailing address

23 MEADOW LN
DUXBURY MA
02332-4113
US

V. Phone/Fax

Practice location:
  • Phone: 508-746-3944
  • Fax: 508-746-3944
Mailing address:
  • Phone: 781-291-9843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: