Provider Demographics
NPI:1013445337
Name:BEN HERMAN ALLIANCE, LLC
Entity Type:Organization
Organization Name:BEN HERMAN ALLIANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-266-9258
Mailing Address - Street 1:2711 CENTERVILLE ROAD, SUITE 400
Mailing Address - Street 2:PNB #622
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2711 CENTERVILLE RD STE 400
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1645
Practice Address - Country:US
Practice Address - Phone:480-266-9258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty