Provider Demographics
NPI:1760757017
Name:BLOND, BENJAMIN NEIL (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:NEIL
Last Name:BLOND
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:SBUMC HSC LEVEL 12, RM 020
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8121
Mailing Address - Country:US
Mailing Address - Phone:631-444-2599
Mailing Address - Fax:
Practice Address - Street 1:SBUMC HSC LEVEL 12, RM 020
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8121
Practice Address - Country:US
Practice Address - Phone:631-444-2599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0555452084N0400X
NY2924762084E0001X, 2084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program