Provider Demographics
NPI:1801203591
Name:BENSON, BRIANA M (PA)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:M
Last Name:BENSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:M
Other - Last Name:BET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:50 NEW SCOTLAND AVE
Mailing Address - Street 2:DIVISION OF PLASTIC SURGERY; MAIL CODE 190
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3403
Mailing Address - Country:US
Mailing Address - Phone:518-262-2229
Mailing Address - Fax:
Practice Address - Street 1:50 NEW SCOTLAND AVE
Practice Address - Street 2:DIVISION OF PLASTIC SURGERY; MAIL CODE 190
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3403
Practice Address - Country:US
Practice Address - Phone:518-262-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2017-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017745363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03985059Medicaid
NYJ400296062Medicare PIN