Provider Demographics
NPI:1043414451
Name:GARTRELL, BENJAMIN ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ADAM
Last Name:GARTRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E 210 ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:718-405-8404
Mailing Address - Fax:718-405-8433
Practice Address - Street 1:111 E 210TH ST # 100
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-405-8404
Practice Address - Fax:718-405-8433
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.010155207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine