NPIMap

Individual provider Active NPI

Benjamin Tack, DO

  • Infectious Disease Physician
  • Roseland, NJ
National Provider Identifier
1215426812
Registry record updated Aug 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
25MB11904700 Issued in NJ
Practice address
189 Eagle Rock Ave
Roseland, NJ 07068-1347
Phone
(845) 853-5739
NPI assigned
May 9, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X 25MB11904700 NJ Primary

Addresses

Primary practice location

189 Eagle Rock Ave
Roseland, NJ 07068-1347

Mailing address

189 Eagle Rock Ave
Roseland, NJ 07068-1347
Phone (845) 853-5739

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230822003237 NJ Practitioner - Internal MedicinePractitioner - Infectious Disease 3779946876 Reassigns benefits to 1 organization
I20251007001569 NY Practitioner - Infectious Disease 3779946876 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Infectious Disease
Education
New York College of Osteo Medicine of New York Institute of Technology, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Albany Medical CollegeGroup PAC ID 1759293111, 1,054 clinicians

Practice addresses (Care Compare)

43 New Scotland Ave
Albany, NY 12208-3412
Phone (518) 262-3277

47 New Scotland Ave
Albany, NY 12208-3412
Phone (518) 262-5633

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
69.61 of 100Reported as group
Quality
95
Improvement activities
0
Cost
72.03

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Infectious Disease Specialists LLC Infectious Disease CurrentSince Aug 1, 2023 Accepting new patients
Albany Medical College CurrentSince Sep 2, 2025 Accepting new patients
Albany Medical College CurrentSince Sep 2, 2025 Accepting new patients
Albany Medical College Infectious Disease Past Accepting new patients
Smith Center for Infectious Diseases and Urban Health, P.a. Past Accepting new patients

Locations

310 Central Ave
Ste 307
East Orange, NJ 07018
Phone (862) 772-7822

189 Eagle Rock Ave
Roseland, NJ 07068
Phone (973) 226-3359

47 New Scotland Ave
Albany, NY 12208
Phone (518) 262-3773

25 Hackett Blvd
#69
Albany, NY 12208
Phone (518) 262-0091

Interoperability endpoints

  • Direct secure messaging: btack1330732@ahs.direct-ci.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724284800000",
    "number": "1215426812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "189 EAGLE ROCK AVE",
            "city": "ROSELAND",
            "state": "NJ",
            "postal_code": "070681347",
            "telephone_number": "845-853-5739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "189 EAGLE ROCK AVE",
            "city": "ROSELAND",
            "state": "NJ",
            "postal_code": "070681347",
            "telephone_number": "845-853-5739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACK",
        "first_name": "BENJAMIN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-09",
        "last_updated": "2024-08-22",
        "certification_date": "2024-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NJ",
            "license": "25MB11904700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseland, NJ

Sources for this page

Verify at the official NPI Registry.