Provider Demographics
NPI:1619154101
Name:HENTEL, BENJAMIN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:MARK
Last Name:HENTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2678 SOUTH RD STE 202
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5254
Mailing Address - Country:US
Mailing Address - Phone:845-790-5700
Mailing Address - Fax:845-790-5719
Practice Address - Street 1:45 READE PL
Practice Address - Street 2:VASSAR BROTHER MEDICAL CENTER
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3947
Practice Address - Country:US
Practice Address - Phone:845-454-4700
Practice Address - Fax:845-454-4982
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2361262085R0202X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03013307Medicaid
NYA400007942Medicare PIN
NYA400007940Medicare PIN
NY03013307Medicaid