Provider Demographics
NPI:1245328186
Name:BENENSON, ALEXANDER (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:BENENSON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3043 OCEAN AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3400
Mailing Address - Country:US
Mailing Address - Phone:718-891-2727
Mailing Address - Fax:718-891-2797
Practice Address - Street 1:3043 OCEAN AVE STE 107
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3400
Practice Address - Country:US
Practice Address - Phone:718-891-2727
Practice Address - Fax:718-891-2797
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171168207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01166994Medicaid
511747OtherAETNA
NY0064305OtherGHI
NYKS476OtherOXFORD HEALTH PLAN
BKX0952-01OtherAMERICHOICE
511747OtherAETNA
NYE95814Medicare UPIN