Provider Demographics
NPI:1679790778
Name:BEN SHWACHMAN MD APC
Entity type:Organization
Organization Name:BEN SHWACHMAN MD APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHWACHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-967-1606
Mailing Address - Street 1:315 N 3RD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1905
Mailing Address - Country:US
Mailing Address - Phone:626-967-3176
Mailing Address - Fax:626-967-8743
Practice Address - Street 1:315 N 3RD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1905
Practice Address - Country:US
Practice Address - Phone:626-967-3176
Practice Address - Fax:626-967-8743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG11026208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG11026Medicare ID - Type Unspecified
CAB50881Medicare UPIN