Healthcare Provider Details

I. General information

NPI: 1023242393
Provider Name (Legal Business Name): BENJAMIN P LAFERRIERE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5187 SCHOOL RD S
EXPORT PA
15632-1824
US

IV. Provider business mailing address

29 MYRTLE AVE
MADISON NJ
07940-1234
US

V. Phone/Fax

Practice location:
  • Phone: 484-804-1175
  • Fax:
Mailing address:
  • Phone: 973-590-6054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD453281
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1023242393
Identifier TypeOTHER
Identifier State
Identifier IssuerN/A

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: