Healthcare Provider Details

I. General information

NPI: 1033882261
Provider Name (Legal Business Name): BENJAMIN SOUFERI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2021
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # JJ24
CLEVELAND OH
44195-3923
US

IV. Provider business mailing address

121 ANDOVER RD
ROSLYN HEIGHTS NY
11577-1803
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2200
  • Fax:
Mailing address:
  • Phone: 516-343-6426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number34.017971
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.017971
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number332470
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: