Healthcare Provider Details

I. General information

NPI: 1093173569
Provider Name (Legal Business Name): DR. BENAIFER D. PREZIOSI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 NEW RD SUITE 32
LINWOOD NJ
08221-2025
US

IV. Provider business mailing address

199 NEW RD SUITE 32
LINWOOD NJ
08221-2025
US

V. Phone/Fax

Practice location:
  • Phone: 609-927-9090
  • Fax: 609-927-9091
Mailing address:
  • Phone: 609-927-9090
  • Fax: 609-927-9091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number22DI02353700
License Number StateNJ

VIII. Authorized Official

Name: DR. BENAIFER DON PREZIOSI
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 609-927-9090