Healthcare Provider Details

I. General information

NPI: 1710087929
Provider Name (Legal Business Name): BENJAMIN BUKHOLTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W 60TH ST SUITE 1N
NEW YORK NY
10023-7902
US

IV. Provider business mailing address

30 W 60TH ST SUITE 1N
NEW YORK NY
10023-7902
US

V. Phone/Fax

Practice location:
  • Phone: 212-581-1300
  • Fax: 212-581-4460
Mailing address:
  • Phone: 212-581-1300
  • Fax: 212-581-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number202438
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: