Provider Demographics
NPI:1508015082
Name:BABU, BENSON ABBI (MD)
Entity Type:Individual
Prefix:
First Name:BENSON
Middle Name:ABBI
Last Name:BABU
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 1:630 1ST AVE
Mailing Address - Street 2:APT STE 28B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3700
Mailing Address - Country:US
Mailing Address - Phone:646-493-4070
Mailing Address - Fax:646-896-1085
Practice Address - Street 1:630 1ST AVE
Practice Address - Street 2:APT STE 28B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3700
Practice Address - Country:US
Practice Address - Phone:646-493-4070
Practice Address - Fax:646-896-1085
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD442212207R00000X, 207R00000X
NY248955208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3006259Medicaid
OHH006692Medicare PIN