Provider Demographics
NPI:1912216508
Name:BENJAMIN ALGAZE, PH.D., P.A.
Entity Type:Organization
Organization Name:BENJAMIN ALGAZE, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALGAZE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-586-2686
Mailing Address - Street 1:21304 NE 19TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-1517
Mailing Address - Country:US
Mailing Address - Phone:305-586-2686
Mailing Address - Fax:786-320-5475
Practice Address - Street 1:21304 NE 19TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-1517
Practice Address - Country:US
Practice Address - Phone:305-586-2686
Practice Address - Fax:786-320-5475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3339103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75462Medicare UPIN