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NPI Code Detail

MEDICARE: DR. TAVYA BENJAMIN M.D.

MEDICARE: DR. TAVYA BENJAMIN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2208800000XUrology Physician316920-01NY

General Provider Information

NPI Number : 1578096657
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TAVYA BENJAMIN M.D.
Provider Business Mailing Address
First Line : 450 LAKEVILLE RD
Second Line :
City : NEW HYDE PARK
State : NY
Zip : 11042-1118
Country : US
Telephone Number : 516-734-8500
Fax Number :
Provider Business Practice Location Address
First Line : 101 SAINT ANDREWS LN
Second Line :
City : GLEN COVE
State : NY
Zip : 11542-2263
Country : US
Telephone Number : 516-734-8500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2017
Last Update Date : 06/30/2022

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