Healthcare Provider Details

I. General information

NPI: 1447839923
Provider Name (Legal Business Name): LOGAN BENJAMIN GREENBLATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2021
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 PLAIN STREET 3RD FLOOR SUITE 101
PROVIDENCE RI
02902-3436
US

IV. Provider business mailing address

372 CENTRAL PARK W APT 18R
NEW YORK NY
10025-8212
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-5504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number330544
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberLP06489
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: