Healthcare Provider Details

I. General information

NPI: 1245328186
Provider Name (Legal Business Name): ALEXANDER BENENSON M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3043 OCEAN AVE STE 107
BROOKLYN NY
11235-3400
US

IV. Provider business mailing address

3043 OCEAN AVE STE 107
BROOKLYN NY
11235-3400
US

V. Phone/Fax

Practice location:
  • Phone: 718-891-2727
  • Fax: 718-891-2797
Mailing address:
  • Phone: 718-891-2727
  • Fax: 718-891-2797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number171168
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: