Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 276096 | NY |
N | 208600000X | Surgeon | 276096 | NY |
N | 208200000X | Surgeon | MD-16466 | HI |
N | 208600000X | Surgeon | MD-16466 | HI |
N | 2086S0102X | Surgical Critical Care | 25MA07594200 | NJ |
N | 2086S0102X | Surgical Critical Care | 276096 | NY |
N | 2086S0102X | Surgical Critical Care | MD-16466 | HI |
N | 2086S0127X | Trauma Surgeon | 25MA07594200 | NJ |
Y | 2086S0127X | Trauma Surgeon | 276096 | NY |
N | 2086S0127X | Trauma Surgeon | MD-16466 | HI |
NPI | 1083811806 |
---|---|
Provider Name | Benjamin Ari Hagendorf |
First Address | Bordentown, NJ 08505-4208 |
Second Address | Bordentown, NJ 08505-4208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2007 |
Last Update Date | 26/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0207551 | (05) | NY |
276096 | MEDICAL LICENSE (01) | NY |
MA07594200 | MEDICAL LICENSE (01) | NJ |
MD-16466 | MEDICAL LICENSE (01) | HI |