Healthcare Provider Details

I. General information

NPI: 1174108633
Provider Name (Legal Business Name): IRA BENSTEIN MS, ED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 RIVER AVE STE 9G
LAKEWOOD NJ
08701-5657
US

IV. Provider business mailing address

1233 STEEPLECHASE CT
TOMS RIVER NJ
08755-2217
US

V. Phone/Fax

Practice location:
  • Phone: 844-458-0196
  • Fax:
Mailing address:
  • Phone: 732-905-9452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: