Provider Demographics
NPI:1457641037
Name:KUMMER, BENJAMIN R (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:R
Last Name:KUMMER
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 1:1 GUSTAVE LEVY PLACE
Mailing Address - Street 2:BOX 1137
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-241-5050
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE LEVY PLACE
Practice Address - Street 2:ANNENBERG 14-10
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-1002
Practice Address - Country:US
Practice Address - Phone:212-241-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY273745-12084V0102X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology