Provider Demographics
NPI:1912063819
Name:BENMEN, ELDAD S (MD)
Entity type:Individual
Prefix:DR
First Name:ELDAD
Middle Name:S
Last Name:BENMEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ELDAD
Other - Middle Name:S
Other - Last Name:BEN MENACHEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:260 21 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004
Mailing Address - Country:US
Mailing Address - Phone:718-347-4288
Mailing Address - Fax:718-347-7521
Practice Address - Street 1:260 21 UNION TPKE
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004
Practice Address - Country:US
Practice Address - Phone:718-347-4288
Practice Address - Fax:718-347-7521
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184465207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01342561Medicaid
04860Medicare ID - Type Unspecified
NY01342561Medicaid