Individual
BENJAMIN SHEPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
3424 KOSSUTH AVE, BRONX, NY 10467-2410
(718) 519-3113
(718) 519-5001
Mailing address
3424 KOSSUTH AVE, BRONX, NY 10467-2410
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
23 015192
NY
Other
Enumeration date
10/10/2011
Last updated
10/10/2011
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