Provider Demographics
NPI:1104021047
Name:IRWIN BENJAMIN CORP
Entity Type:Organization
Organization Name:IRWIN BENJAMIN CORP
Other - Org Name:BENJAMIN OPTICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTICIAN OPHTHALMIC DISPENCER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-666-3620
Mailing Address - Street 1:248 WEST 116
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2450
Mailing Address - Country:US
Mailing Address - Phone:212-666-3620
Mailing Address - Fax:212-666-3985
Practice Address - Street 1:248 WEST 116 ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-2450
Practice Address - Country:US
Practice Address - Phone:212-666-3620
Practice Address - Fax:212-666-3985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY43721332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6032690001Medicare NSC