Provider Demographics
NPI:1295884773
Name:PAVLIDES & BENSON OB/GYN ASSOCIATES, PC
Entity type:Organization
Organization Name:PAVLIDES & BENSON OB/GYN ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:DELACRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-273-5500
Mailing Address - Street 1:2 TELEPORT DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10311-1006
Mailing Address - Country:US
Mailing Address - Phone:718-273-5500
Mailing Address - Fax:718-273-3232
Practice Address - Street 1:2 TELEPORT DR
Practice Address - Street 2:SUITE 207
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10311-1006
Practice Address - Country:US
Practice Address - Phone:718-273-5500
Practice Address - Fax:718-273-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206780207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG81500Medicare UPIN
NYWDW511Medicare PIN
NYH72320Medicare UPIN