Provider Demographics
NPI:1609000843
Name:BEN-ISRAEL, ADY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ADY
Middle Name:
Last Name:BEN-ISRAEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 COURT ST STE 800
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4414
Mailing Address - Country:US
Mailing Address - Phone:347-788-1636
Mailing Address - Fax:
Practice Address - Street 1:44 COURT ST STE 800
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4414
Practice Address - Country:US
Practice Address - Phone:347-788-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-02
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021886103TC0700X
NY0778891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1285628552OtherAGENCY
NYWVE061OtherMEDICARE #
02449154OtherMEDICAD #