Individual
DR. IGOR L BENENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O., M.D., PH.D.
Contact information
Practice address
9892 BUSTLETON AVE, SUITE 306, PHILADELPHIA, PA 19115-2184
(215) 969-0300
(215) 969-4300
Mailing address
9892 BUSTLETON AVE, SUITE 306, PHILADELPHIA, PA 19115-2184
(215) 969-0300
(215) 969-4300
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
OS012126
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1009797730001
—
PA
01
—
200889503
TAX ID
PA
01
—
2329273000
INDEPENDENCE BLUE CROSS
PA
01
—
7029541
AETNA
PA
Enumeration date
07/19/2006
Last updated
12/13/2023
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