Provider Demographics
NPI:1760996334
Name:BENJAMIN, PETER (DPT)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9819 64TH AVE APT 3B
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2525
Mailing Address - Country:US
Mailing Address - Phone:908-462-4766
Mailing Address - Fax:
Practice Address - Street 1:158 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-8766
Practice Address - Country:US
Practice Address - Phone:718-880-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-19
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042636208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation