Provider Demographics
NPI:1700292430
Name:SRIVASTAVA, A BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:A
Middle Name:BENJAMIN
Last Name:SRIVASTAVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:A BENJAMIN
Other - Middle Name:
Other - Last Name:SRIVASTAVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1051 RIVERSIDE DR UNIT 66
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1007
Mailing Address - Country:US
Mailing Address - Phone:646-774-5000
Mailing Address - Fax:
Practice Address - Street 1:1051 RIVERSIDE DR UNIT 66
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1007
Practice Address - Country:US
Practice Address - Phone:646-774-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2926022084P0800X
MO20160138232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry