Doctor Name: | DR. BENJAMIN MARK |
NPI Number: | 1093704199 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | MA42033 |
Business Practice Address: | 279 3rd Ave Suite 301 Long Branch, NJ - 077406205 |
Business Phone Number: | 7322293737 |
Business Fax Number: | 7322295757 |
Mailing Address: | 279 3rd Ave, Suite 301 LONG BRANCH |
State: | NJ |
Postal Code: | 077406205 |
Phone Number: | 7322293737 |
Fax Number: | 7322295757 |
NPI Enumeration Date: | 10/20/2005 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MA42033 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |