Provider Demographics
NPI:1023135100
Name:UMEZE, BEN O (MD)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:O
Last Name:UMEZE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1423 GLOVER STREET
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-4919
Mailing Address - Country:US
Mailing Address - Phone:718-597-8383
Mailing Address - Fax:718-892-0234
Practice Address - Street 1:1423 GLOVER STREET
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-4919
Practice Address - Country:US
Practice Address - Phone:718-597-8383
Practice Address - Fax:718-892-0234
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2014-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1528162083P0500X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00928074Medicaid
B17104Medicare UPIN
61D581Medicare ID - Type Unspecified