Healthcare Provider Details

I. General information

NPI: 1538348057
Provider Name (Legal Business Name): BENSON MEDICAL IMAGING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3858 NOSTRAND AVE
BROOKLYN NY
11235-2038
US

IV. Provider business mailing address

3858 NOSTRAND AVE
BROOKLYN NY
11235-2038
US

V. Phone/Fax

Practice location:
  • Phone: 718-368-4161
  • Fax: 718-368-4162
Mailing address:
  • Phone: 718-368-4161
  • Fax: 718-368-4162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number157428
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number157428
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number157428
License Number StateNY

VIII. Authorized Official

Name: DR. RICHARD DENISE
Title or Position: SOLE MEMBER
Credential: MD
Phone: 718-368-4161