Provider Demographics
NPI:1982946398
Name:BEN TAUB MEDICAL INSTITUTE
Entity Type:Organization
Organization Name:BEN TAUB MEDICAL INSTITUTE
Other - Org Name:BEN TAUB INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DEIRECTOR - MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:PANCZEL
Authorized Official - Last Name:GRAUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-270-6491
Mailing Address - Street 1:16055 VENTURA BLVD STE 1120
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2612
Mailing Address - Country:US
Mailing Address - Phone:818-270-6491
Mailing Address - Fax:
Practice Address - Street 1:16055 VENTURA BLVD STE 1120
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2612
Practice Address - Country:US
Practice Address - Phone:818-270-6491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARTIN P GRAUMANN MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-24
Last Update Date:2013-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47960261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1558603944Medicaid
CA1558603944Medicare PIN
CA1558603944Medicare NSC
CA1558603944Medicaid
CA1558603944Medicare Oscar/Certification