Provider Demographics
NPI:1780691840
Name:BENJAMIN, LINDA LAZARUS (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:LAZARUS
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 1:50 LAKEFRONT BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-4327
Mailing Address - Country:US
Mailing Address - Phone:716-849-8750
Mailing Address - Fax:716-849-8756
Practice Address - Street 1:50 LAKEFRONT BLVD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-4327
Practice Address - Country:US
Practice Address - Phone:716-849-8750
Practice Address - Fax:716-849-8756
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135545208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00722514Medicaid
NY6409370OtherIHA
NY00010014301OtherUNIVERA
NY005085852OtherBCBS
NY00722514Medicaid
NY005085852OtherBCBS