Provider Demographics
NPI:1265553085
Name:DELGADO, BENJAMIN JR
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:DELGADO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N KRAMER AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-1943
Mailing Address - Country:US
Mailing Address - Phone:630-561-2075
Mailing Address - Fax:630-873-5441
Practice Address - Street 1:701 N KRAMER AVE
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-1943
Practice Address - Country:US
Practice Address - Phone:630-561-2075
Practice Address - Fax:630-873-5441
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILBD38020901P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist