Healthcare Provider Details

I. General information

NPI: 1982434882
Provider Name (Legal Business Name): MICHECA BENJAMIN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHECA BENJAMIN CNM

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WILLIAMSON ST STE 350
ELIZABETH NJ
07202-2909
US

IV. Provider business mailing address

379 CAMPUS DR
SOMERSET NJ
08873-1161
US

V. Phone/Fax

Practice location:
  • Phone: 908-994-5500
  • Fax: 908-994-5815
Mailing address:
  • Phone: 732-937-8939
  • Fax: 732-418-8372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number25ME00087400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: