Provider Demographics
NPI:1164489803
Name:ZOGHLIN, BENSON LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:BENSON
Middle Name:LOUIS
Last Name:ZOGHLIN
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 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-392-9100
Mailing Address - Fax:585-392-6292
Practice Address - Street 1:279 EAST AVE
Practice Address - Street 2:HILTON HEALTH CARE, P.C.
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-1333
Practice Address - Country:US
Practice Address - Phone:585-392-9100
Practice Address - Fax:585-392-4020
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169892208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01041721Medicaid
NY0009148344001OtherHEALTHNOW
NYCFP1698927OtherWORKERS COMPENSATION
NY010169892OtherBLUE CHOICE
NYMD129DOtherPREFERRED CARE
NY7764326OtherAETNA
NY6950OtherBLUE CROSS BLUE SHIELD
NY13243DMedicare PIN