Provider Demographics
NPI:1548405012
Name:BARON, BENJAMIN S (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:S
Last Name:BARON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 DOUGHTY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1312
Mailing Address - Country:US
Mailing Address - Phone:516-732-1950
Mailing Address - Fax:
Practice Address - Street 1:38 DOUGHTY BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1312
Practice Address - Country:US
Practice Address - Phone:516-732-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015495261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ7W2Y1Medicare PIN