Provider Information for 1588891196
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Dr. BENJAMIN T RISTAU MD
Sex: Male
NPI: 1588891196
Last Updated: 2022-09-28
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1588891196 | ||||||||||||||
| Enumeration Date | 2009-06-22 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 2450 W HUNTING PARK AVE PHILADELPHIA, PA 19129-1302 United States Phone: | Fax: | ||||||||||||||
| Primary Practice Address | 333 COTTMAN AVE PHILADELPHIA, PA 19111-2434 United States Phone: 215-728-6900 | Fax:215-214-3779 | ||||||||||||||
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