Healthcare Provider Details

I. General information

NPI: 1750840021
Provider Name (Legal Business Name): JAMIE ROSS BENSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2019
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 1ST AVE # 6C
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

530 1ST AVE # 6C
NEW YORK NY
10016-6402
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number335421-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: