Healthcare Provider Details

I. General information

NPI: 1164192027
Provider Name (Legal Business Name): KAITLYN BENDER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RIVERFRONT PLZ STE 300
NEWARK NJ
07102-5412
US

IV. Provider business mailing address

1216 CLOVER RD
BRICK NJ
08724-1013
US

V. Phone/Fax

Practice location:
  • Phone: 201-273-7047
  • Fax: 855-998-4358
Mailing address:
  • Phone: 732-610-8136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LH0002X
TaxonomyHospice and Palliative Medicine (Anesthesiology) Physician
License Number26NJ01190400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNJ2601190400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number26NJ01190400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: