Healthcare Provider Details

I. General information

NPI: 1164042313
Provider Name (Legal Business Name): BENJAMIN LEVI KAPLAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 WILLS WAY
PISCATAWAY NJ
08854-3770
US

IV. Provider business mailing address

169 RIVERSIDE DR
BINGHAMTON NY
13905-4246
US

V. Phone/Fax

Practice location:
  • Phone: 732-968-3833
  • Fax: 732-268-5880
Mailing address:
  • Phone: 607-798-5280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00376000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: