Provider Demographics
NPI:1447060413
Name:BENJAMIN, NOAH
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-654-0880
Mailing Address - Fax:570-655-9857
Practice Address - Street 1:42 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-1916
Practice Address - Country:US
Practice Address - Phone:570-654-0880
Practice Address - Fax:570-655-9857
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA066217363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant