Provider Demographics
NPI:1356303739
Name:PENG, BENJAMIN C H (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:C H
Last Name:PENG
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 1:95 OLD LAKE ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10604-1508
Mailing Address - Country:US
Mailing Address - Phone:914-997-2720
Mailing Address - Fax:212-226-0134
Practice Address - Street 1:168 CANAL ST
Practice Address - Street 2:SUITE 510
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4503
Practice Address - Country:US
Practice Address - Phone:212-226-2200
Practice Address - Fax:212-226-0134
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166349-1208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01241423Medicaid
NY36F121Medicare ID - Type Unspecified
NY01241423Medicaid