Healthcare Provider Details

I. General information

NPI: 1710088539
Provider Name (Legal Business Name): BENJAMIN WILLIAM KIRSCHENBAUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 NORTHERN PKWY W
PLAINVIEW NY
11803-1900
US

IV. Provider business mailing address

120 NORTHERN PKWY W
PLAINVIEW NY
11803-1900
US

V. Phone/Fax

Practice location:
  • Phone: 516-938-3949
  • Fax: 631-862-3604
Mailing address:
  • Phone: 516-938-3949
  • Fax: 631-862-3604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number159785-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number159785
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00972481
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: