Healthcare Provider Details

I. General information

NPI: 1336076637
Provider Name (Legal Business Name): BENAVIDES FOOT & ANKLE LTD LIABILITY CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GRAND ST
HOBOKEN NJ
07030-8546
US

IV. Provider business mailing address

200 GRAND ST
HOBOKEN NJ
07030-8546
US

V. Phone/Fax

Practice location:
  • Phone: 845-522-4072
  • Fax:
Mailing address:
  • Phone: 845-522-4072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: ERICK BENAVIDES
Title or Position: OWNER
Credential: DPM
Phone: 845-522-4072