Provider Demographics
NPI:1952562159
Name:YEROUSHALMI, ALLEN BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:BENJAMIN
Last Name:YEROUSHALMI
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 1:20058 VENTURA BLVD
Mailing Address - Street 2:# 139
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2637
Mailing Address - Country:US
Mailing Address - Phone:914-725-5556
Mailing Address - Fax:914-725-5597
Practice Address - Street 1:9001 WILSHIRE BLVD STE 306
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1841
Practice Address - Country:US
Practice Address - Phone:424-666-1597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112058207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
6427784OtherCIGNA
12365420OtherCAQH
MD335719OtherMCARE PTAN
1952562159OtherNPI
MD076414100Medicaid
MD46-4026869OtherMARYLAND EIN #
MDD76762OtherMEDICAL LICENSE
MD334886YYCD EFF 2514OtherMEDICARE GROUP MEMBER PTAN
MD1245660075OtherMEDICARE GROUP NPI