Provider Demographics
NPI:1942504543
Name:BEN I PREMINGER, PC
Entity Type:Organization
Organization Name:BEN I PREMINGER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:I
Authorized Official - Last Name:PREMINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-851-8351
Mailing Address - Street 1:1659 55TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1824
Mailing Address - Country:US
Mailing Address - Phone:718-851-8351
Mailing Address - Fax:718-851-0789
Practice Address - Street 1:1659 55TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1824
Practice Address - Country:US
Practice Address - Phone:718-851-8351
Practice Address - Fax:718-851-0789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128725208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00602575Medicaid
NYA62490Medicare UPIN