Healthcare Provider Details

I. General information

NPI: 1114958717
Provider Name (Legal Business Name): ARI BENJAMIN LERNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 CRESCENT ST
ASTORIA NY
11102-4370
US

IV. Provider business mailing address

2515 CRESCENT ST
ASTORIA NY
11102-4370
US

V. Phone/Fax

Practice location:
  • Phone: 718-932-1740
  • Fax: 718-728-1730
Mailing address:
  • Phone: 718-932-1740
  • Fax: 718-728-1730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number234524
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number234524
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: