Provider Demographics
NPI:1891141883
Name:REINHARDT, BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:REINHARDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 OCEAN AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1484
Mailing Address - Country:US
Mailing Address - Phone:212-398-1288
Mailing Address - Fax:718-332-3454
Practice Address - Street 1:2148 OCEAN AVE FL 5
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1484
Practice Address - Country:US
Practice Address - Phone:212-398-1288
Practice Address - Fax:718-332-3454
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302390207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty