Healthcare Provider Details

I. General information

NPI: 1336312420
Provider Name (Legal Business Name): BRIAN ERIC BENSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 11/16/2024
Certification Date: 11/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE SUITE 613
HACKENSACK NJ
07601-1997
US

IV. Provider business mailing address

331 NEWMAN SPRINGS RD STE 220
RED BANK NJ
07701-5792
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2750
  • Fax: 551-228-7606
Mailing address:
  • Phone: 732-807-0877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25MA08215300
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1134472343
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerNPI
# 2
Identifier260149
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerPTAN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: