Healthcare Provider Details

I. General information

NPI: 1043638489
Provider Name (Legal Business Name): BENJAMIN MARGOLIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 MYRTLE AVE STE 200
ALBANY NY
12208-3835
US

IV. Provider business mailing address

391 MYRTLE AVE STE 200
ALBANY NY
12208-3835
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-4942
  • Fax: 518-262-5291
Mailing address:
  • Phone: 518-262-4942
  • Fax: 518-262-5291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number292534
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: