Healthcare Provider Details

I. General information

NPI: 1013365014
Provider Name (Legal Business Name): BENJAMIN MAX KAMMERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4433 VESTAL PKWY E
VESTAL NY
13850-3556
US

IV. Provider business mailing address

33 LEWIS RD
BINGHAMTON NY
13905-1048
US

V. Phone/Fax

Practice location:
  • Phone: 607-771-2220
  • Fax: 607-251-2635
Mailing address:
  • Phone: 607-770-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number290955
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: