Provider Demographics
NPI:1043396047
Name:BENEDITSKIY, IGOR (MD, DO)
Entity Type:Individual
Prefix:DR
First Name:IGOR
Middle Name:
Last Name:BENEDITSKIY
Suffix:
Gender:M
Credentials:MD, DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3743 MERMAID AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-1234
Mailing Address - Country:US
Mailing Address - Phone:718-576-1212
Mailing Address - Fax:718-332-7110
Practice Address - Street 1:2646 E 14TH ST UNIT 1M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3916
Practice Address - Country:US
Practice Address - Phone:718-576-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237675204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02810406Medicaid
NY897801Medicare ID - Type Unspecified