Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 237675 | NY |
N | 207Q00000X | Family Doctor | 237675 | NY |
NPI | 1043396047 |
---|---|
Provider Name | Dr. Igor Beneditskiy |
First Address | Brooklyn, NY 11224-1234 |
Second Address | Brooklyn, NY 11235-7870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 24/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I48649 | (02) | NY |