Healthcare Provider Details

I. General information

NPI: 1154588234
Provider Name (Legal Business Name): BENNETT ASSIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2008
Last Update Date: 05/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 HAVENS MILL RD
FREEHOLD NJ
07728-3060
US

IV. Provider business mailing address

115 HAVENS MILL RD
FREEHOLD NJ
07728-3060
US

V. Phone/Fax

Practice location:
  • Phone: 908-415-8160
  • Fax: 732-308-1544
Mailing address:
  • Phone: 908-415-8160
  • Fax: 732-308-1544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number26NO08550000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number26NO0855000
License Number StateNJ

VIII. Authorized Official

Name: MRS. HEIDI JONES BENNETT
Title or Position: CRNFA
Credential: CRNFA
Phone: 908-415-8160