MEDICARE: BENJAMIN ADLER

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
1	363A00000X	Physician Assistant	031918	NY

General Provider Information

NPI Number	:	1598516007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN ADLER

Provider Business Mailing Address
First Line	:	19 BAY 34TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4207
Country	:	US
Telephone Number	:	347-226-8036
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 BAY 34TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4207
Country	:	US
Telephone Number	:	864-881-1214
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2024
Last Update Date	:	12/22/2024

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Directions to “ BENJAMIN ADLER ” Practice Location

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