Healthcare Provider Details

I. General information

NPI: 1164052510
Provider Name (Legal Business Name): BENJAMIN MICHAEL SCHECHTER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1822
US

IV. Provider business mailing address

725 EASTERN PKWY APT 4
BROOKLYN NY
11213-3412
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-5000
  • Fax:
Mailing address:
  • Phone: 310-413-3912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number024363-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: