Healthcare Provider Details

I. General information

NPI: 1265272850
Provider Name (Legal Business Name): JANET BENJAMIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 S SALINA ST
SYRACUSE NY
13202-3570
US

IV. Provider business mailing address

819 S SALINA ST
SYRACUSE NY
13202-3570
US

V. Phone/Fax

Practice location:
  • Phone: 315-476-7921
  • Fax:
Mailing address:
  • Phone: 315-476-7921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP126272
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: