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General NPI Number Information
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NPI Number | 1447839923
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Entity Type | Individual
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Provider Name | LOGAN BENJAMIN GREENBLATT MD
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Gender | Male
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Dates
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Enumeration Date | 04/03/2021
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 111 PLAIN STREET 3RD FLOOR SUITE 101
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City | PROVIDENCE
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State | RI
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Zip | 02902-3436
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Country | US
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Telephone | 401-444-5504
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Fax |
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Provider Business Mailing Address
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Address Line | 372 CENTRAL PARK W APT 18R
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City | NEW YORK
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State | NY
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Zip | 10025-8212
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 330544
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | LP06489
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License Number State | RI
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