Provider Demographics
NPI:1477075307
Name:SMIT, BENJAMIN ROGIN (PT, DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ROGIN
Last Name:SMIT
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10175-0003
Mailing Address - Country:US
Mailing Address - Phone:212-692-9558
Mailing Address - Fax:
Practice Address - Street 1:521 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10175
Practice Address - Country:US
Practice Address - Phone:212-692-9558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACP018443T225100000X
NY041695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist