Provider Demographics
NPI:1477638088
Name:SUSSMAN, BENJAMIN MATTHEW (DO)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:MATTHEW
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4533 NEW FALLS RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-3004
Mailing Address - Country:US
Mailing Address - Phone:267-540-8220
Mailing Address - Fax:609-537-7072
Practice Address - Street 1:4533 NEW FALLS RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056-3004
Practice Address - Country:US
Practice Address - Phone:267-540-8220
Practice Address - Fax:609-537-7072
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA168490Medicare UPIN