Provider Demographics
NPI:1891756474
Name:BENJAMIN, BURTON IRVING (MD)
Entity Type:Individual
Prefix:DR
First Name:BURTON
Middle Name:IRVING
Last Name:BENJAMIN
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 1:41 RIDGECREST RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-3121
Mailing Address - Country:US
Mailing Address - Phone:203-322-6743
Mailing Address - Fax:
Practice Address - Street 1:51 SCHUYLER AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3730
Practice Address - Country:US
Practice Address - Phone:203-327-1187
Practice Address - Fax:203-967-4218
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine