Healthcare Provider Details

I. General information

NPI: 1225102346
Provider Name (Legal Business Name): ROBERT J BENNETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1088 STATE ROUTE 34
ABERDEEN NJ
07747-1948
US

IV. Provider business mailing address

1088 STATE ROUTE 34
ABERDEEN NJ
07747-1948
US

V. Phone/Fax

Practice location:
  • Phone: 732-290-1700
  • Fax: 732-290-0040
Mailing address:
  • Phone: 732-290-1700
  • Fax: 732-290-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA05543800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: