Healthcare Provider Details

I. General information

NPI: 1487941779
Provider Name (Legal Business Name): SARI BENTSIANOV M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARI LANDMAN

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 07/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BERGEN ST STE 4600
NEWARK NJ
07103-2425
US

IV. Provider business mailing address

185 S ORANGE AVE STE F-540
NEWARK NJ
07103-2757
US

V. Phone/Fax

Practice location:
  • Phone: 800-249-7750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number25MA10116200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: