=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265592620
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENSON WEINSTOCK, D.P.M., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2006
-----------------------------------------------------
Last Update Date | 10/29/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2014 S 15TH ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19145-3047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-463-6010
-----------------------------------------------------
Fax | 215-463-4140
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2014 S 15TH ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19145-3047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-463-6010
-----------------------------------------------------
Fax | 215-463-4140
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | FERN WEINSTOCK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-463-6010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | SC002518L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------