Healthcare Provider Details

I. General information

NPI: 1699146902
Provider Name (Legal Business Name): OHIO DRIVE MEDICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 OHIO DR SUITE 101
NEW HYDE PARK NY
11042-1124
US

IV. Provider business mailing address

6 OHIO DR SUITE 101
NEW HYDE PARK NY
11042-1124
US

V. Phone/Fax

Practice location:
  • Phone: 516-222-2022
  • Fax:
Mailing address:
  • Phone: 516-222-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL D. BENJAMIN
Title or Position: DIRECTOR
Credential: M.D.
Phone: 516-222-2022