Healthcare Provider Details

I. General information

NPI: 1487716957
Provider Name (Legal Business Name): ROBERT H BENNETT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 CHESTNUT AVE
MARLTON NJ
08053-7148
US

IV. Provider business mailing address

214 CHESTNUT AVE
MARLTON NJ
08053-7148
US

V. Phone/Fax

Practice location:
  • Phone: 856-220-7023
  • Fax:
Mailing address:
  • Phone: 856-220-7023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMB053757
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMB053757
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: