Provider Demographics
NPI:1649252743
Name:BENJAMIN, JAYE E (MD)
Entity type:Individual
Prefix:DR
First Name:JAYE
Middle Name:E
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36060 EUCLID AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4656
Mailing Address - Country:US
Mailing Address - Phone:440-942-4226
Mailing Address - Fax:440-942-1421
Practice Address - Street 1:36060 EUCLID AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4656
Practice Address - Country:US
Practice Address - Phone:440-942-4226
Practice Address - Fax:440-942-1421
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047445B207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0493854Medicaid
OH070000640OtherRAILROAD MEDICARE
OH0493854Medicaid
OH0516261Medicare PIN