Provider Demographics
NPI:1699146902
Name:OHIO DRIVE MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:OHIO DRIVE MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-222-2022
Mailing Address - Street 1:6 OHIO DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1124
Mailing Address - Country:US
Mailing Address - Phone:516-222-2022
Mailing Address - Fax:
Practice Address - Street 1:6 OHIO DR
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1124
Practice Address - Country:US
Practice Address - Phone:516-222-2022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty