Healthcare Provider Details

I. General information

NPI: 1295884773
Provider Name (Legal Business Name): PAVLIDES & BENSON OB/GYN ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TELEPORT DR SUITE 207
STATEN ISLAND NY
10311-1006
US

IV. Provider business mailing address

2 TELEPORT DR SUITE 207
STATEN ISLAND NY
10311-1006
US

V. Phone/Fax

Practice location:
  • Phone: 718-273-5500
  • Fax: 718-273-3232
Mailing address:
  • Phone: 718-273-5500
  • Fax: 718-273-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number206780
License Number StateNY

VIII. Authorized Official

Name: ERIC DELACRUZ
Title or Position: OFFICER
Credential: MD
Phone: 718-273-5500