Provider Demographics
NPI:1750371977
Name:BENJAMIN, ANAT (MD)
Entity type:Individual
Prefix:
First Name:ANAT
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:516-747-1277
Practice Address - Street 1:305 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2102
Practice Address - Country:US
Practice Address - Phone:516-747-4011
Practice Address - Fax:516-747-1277
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192139207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG24588Medicare UPIN
NY064B13Medicare PIN
NY064B12Medicare PIN
NY04142Medicare PIN