Healthcare Provider Details

I. General information

NPI: 1538081658
Provider Name (Legal Business Name): BENJAMIN PORTAL MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 AUERBACH LN
LAWRENCE NY
11559-2529
US

IV. Provider business mailing address

37 AUERBACH LN
LAWRENCE NY
11559-2529
US

V. Phone/Fax

Practice location:
  • Phone: 516-242-9622
  • Fax:
Mailing address:
  • Phone: 516-242-9622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN PORTAL
Title or Position: OWNER
Credential: M.D.
Phone: 516-242-9622