Provider Demographics
NPI:1336439744
Name:LUONG, BENJAMIN B (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:B
Last Name:LUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3085 HARLEM RD STE 350
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2591
Mailing Address - Country:US
Mailing Address - Phone:716-844-5600
Mailing Address - Fax:716-844-5750
Practice Address - Street 1:117 FOOTE AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6947
Practice Address - Country:US
Practice Address - Phone:716-338-9200
Practice Address - Fax:716-338-9250
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2018-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY284342208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04769348Medicaid