Healthcare Provider Details

I. General information

NPI: 1518428069
Provider Name (Legal Business Name): BENJAMIN BIEDERMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 PARK ST
MONTCLAIR NJ
07042-5915
US

IV. Provider business mailing address

1130 MCBRIDE AVE FL 3
WOODLAND PARK NJ
07424-3806
US

V. Phone/Fax

Practice location:
  • Phone: 973-233-9559
  • Fax:
Mailing address:
  • Phone: 973-785-2277
  • Fax: 973-785-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA12785300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: