Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 033826 | NY |
NPI | 1093831109 |
---|---|
Provider Name | Andrew Benjamin |
First Address | Mount Kisco, NY 10549-3826 |
Second Address | White Plains, NY 10601-3531 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 27/12/2012 |