Provider Demographics
NPI:1356761290
Name:BEN-DOV, ISSAHAR
Entity type:Individual
Prefix:PROF
First Name:ISSAHAR
Middle Name:
Last Name:BEN-DOV
Suffix:
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:POB 208057, TAC-441 SOUTH
Mailing Address - Street 2:300 CEDAR ST, PULMONARY &CRITICAL CARE SECTION
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8057
Mailing Address - Country:US
Mailing Address - Phone:203-785-4162
Mailing Address - Fax:203-785-3826
Practice Address - Street 1:300 CEDAR ST, PULMONARY &CRITICAL CARE SECTION
Practice Address - Street 2:TAC-441 SOUTH
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520-8057
Practice Address - Country:US
Practice Address - Phone:203-785-4162
Practice Address - Fax:203-785-3826
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT52904207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease