Provider Demographics
NPI:1932165628
Name:BENJAMIN, ANTHONY P (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:P
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:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:518-649-4094
Practice Address - Street 1:2231 BURDETT AVE STE 230
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180
Practice Address - Country:US
Practice Address - Phone:518-272-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229456208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1099291OtherGHI PPO#
71021424811OtherMVP VENDOR #
NY02491927Medicaid
100783615671OtherCDPHP GROUP #
P00063770OtherRR MEDICARE
000000076448OtherGHI HMO #
AB035R241OtherDOWN MEDICARE
71021424811OtherMVP VENDOR #
NY02491927Medicaid