Provider Demographics
NPI:1124489521
Name:HERBEST, BENJAMIN
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:HERBEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 MILES ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:ME
Mailing Address - Zip Code:04444-4733
Mailing Address - Country:US
Mailing Address - Phone:207-234-7727
Mailing Address - Fax:207-234-7727
Practice Address - Street 1:195 MILES ROAD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:ME
Practice Address - Zip Code:04444-4733
Practice Address - Country:US
Practice Address - Phone:207-234-7727
Practice Address - Fax:207-234-7727
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker