Provider Demographics
NPI:1710088539
Name:KIRSCHENBAUM, BENJAMIN WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:WILLIAM
Last Name:KIRSCHENBAUM
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 1:120 NORTHERN PKWY W
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1900
Mailing Address - Country:US
Mailing Address - Phone:516-938-3949
Mailing Address - Fax:631-862-3604
Practice Address - Street 1:120 NORTHERN PKWY W
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1900
Practice Address - Country:US
Practice Address - Phone:516-938-3949
Practice Address - Fax:631-862-3604
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159785-1207L00000X
NY159785207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00972481Medicaid
NY00972481Medicaid
NY91D041Medicare ID - Type Unspecified