Provider Demographics
NPI:1609541705
Name:ADAM, BENJAMIN ELEANOR (PHD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ELEANOR
Last Name:ADAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 KINGSLAND AVE APT 3L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4354
Mailing Address - Country:US
Mailing Address - Phone:917-720-8261
Mailing Address - Fax:
Practice Address - Street 1:239 KINGSLAND AVE APT 3L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-4354
Practice Address - Country:US
Practice Address - Phone:917-720-8261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program