Organization
IGOR BENENSON M.D.,D.O.,P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IGOR L BENENSON (PRESIDENT)
(215) 969-0300
Entity
Organization
Contact information
Practice address
9892 BUSTLETON AVE, SUITE 306, PHILADELPHIA, PA 19115-2184
(215) 969-0300
Mailing address
9892 BUSTLETON AVE, SUITE 306, PHILADELPHIA, PA 19115-2184
(215) 969-0300
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
076601SK4
MEDICARE ID TYPE-GROUP
PA
05
—
1009797730001
—
PA
Enumeration date
11/14/2006
Last updated
04/15/2009
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