Provider Demographics
NPI:1366499501
Name:ONGHAI, BENSON GO (MD)
Entity Type:Individual
Prefix:DR
First Name:BENSON
Middle Name:GO
Last Name:ONGHAI
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 711
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-0770
Mailing Address - Country:US
Mailing Address - Phone:631-398-4797
Mailing Address - Fax:
Practice Address - Street 1:285 SILLS RD BLDG 4D
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4857
Practice Address - Country:US
Practice Address - Phone:631-398-4797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2023-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216060208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02059561Medicaid
NY7208093OtherAETNA
NY0388J1OtherEMPIRE BC.BS
NY26Z821Medicare ID - Type Unspecified
NY02059561Medicaid