Healthcare Provider Details

I. General information

NPI: 1477412062
Provider Name (Legal Business Name): BENJAMIN SUBTELNY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 BLVD E APT 17G
WEST NEW YORK NJ
07093-3841
US

IV. Provider business mailing address

6040 BLVD E APT 17G
WEST NEW YORK NJ
07093-3841
US

V. Phone/Fax

Practice location:
  • Phone: 607-351-0187
  • Fax:
Mailing address:
  • Phone: 201-509-5648
  • Fax: 973-833-4177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN JOSEPH SUBTELNY
Title or Position: MANAGING MEMBER
Credential: DDS
Phone: 201-509-5648