Provider Demographics
NPI:1487628004
Name:SEIDBAND, BEN (OD)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:SEIDBAND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11212 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6344
Mailing Address - Country:US
Mailing Address - Phone:718-261-1764
Mailing Address - Fax:718-261-1764
Practice Address - Street 1:11212 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6344
Practice Address - Country:US
Practice Address - Phone:718-261-1764
Practice Address - Fax:718-261-1764
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002580-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY230230OtherUNITED HEALTHCARE
NY905828OtherBLOCK VISION
NY9724462OtherGHI
NY2960956OtherAETNA
NY010047901OtherAMERICHOICE
NY01788816Medicaid
NY168520OtherEYE MED VISION CARE
NYP3871801OtherOXFORD HEALTH PLANS
NY08333GMedicare PIN
NY010047901OtherAMERICHOICE
NY9724462OtherGHI