Healthcare Provider Details

I. General information

NPI: 1972442895
Provider Name (Legal Business Name): BENJAMIN FUNK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4099 NY-145
DURHAM NY
12422
US

IV. Provider business mailing address

240 FISH AND GAME RD
HUDSON NY
12534-9201
US

V. Phone/Fax

Practice location:
  • Phone: 518-697-5661
  • Fax:
Mailing address:
  • Phone: 518-755-3363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: