Provider Demographics
NPI:1417941592
Name:SPIRN, BENJAMIN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DAVID
Last Name:SPIRN
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 1:430 W 24TH ST
Mailing Address - Street 2:APT 3F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1334
Mailing Address - Country:US
Mailing Address - Phone:212-645-4185
Mailing Address - Fax:
Practice Address - Street 1:1656 OAK TREE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2805
Practice Address - Country:US
Practice Address - Phone:732-549-8080
Practice Address - Fax:732-549-0528
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07876000207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0073393Medicaid
NJ0073393Medicaid
NJI28858Medicare UPIN