Provider Demographics
NPI:1528233889
Name:DAVID L BENISCH, MD PC
Entity type:Organization
Organization Name:DAVID L BENISCH, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:BENISCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-423-7000
Mailing Address - Street 1:124 MAIN ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6922
Mailing Address - Country:US
Mailing Address - Phone:631-423-7000
Mailing Address - Fax:631-423-9276
Practice Address - Street 1:124 MAIN ST
Practice Address - Street 2:SUITE 16
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6922
Practice Address - Country:US
Practice Address - Phone:631-423-7000
Practice Address - Fax:631-423-9276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00425470Medicaid
NY00425470Medicaid
NYWYXQV1Medicare PIN