Provider Demographics
NPI:1083765721
Name:BENVENISTY, ALAN IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:IRA
Last Name:BENVENISTY
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:PO BOX 95000-2397
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2397
Mailing Address - Country:US
Mailing Address - Phone:212-523-4706
Mailing Address - Fax:
Practice Address - Street 1:1090 AMSTERDAM AVE
Practice Address - Street 2:12TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1737
Practice Address - Country:US
Practice Address - Phone:212-523-4706
Practice Address - Fax:212-523-4720
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142330174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00865352Medicaid
NY13802Medicare UPIN
NY36D441Medicare ID - Type Unspecified