Provider Demographics
NPI:1407267008
Name:BENJAMIN C LIFSHITZ, MD, PC
Entity Type:Organization
Organization Name:BENJAMIN C LIFSHITZ, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIFSHITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-646-8815
Mailing Address - Street 1:1383 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1928 BAY AVE
Practice Address - Street 2:4TH FLR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6214
Practice Address - Country:US
Practice Address - Phone:718-646-8815
Practice Address - Fax:718-891-8123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167556207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01164589Medicaid
NY01164589Medicaid
NYA60472Medicare UPIN