Healthcare Provider Details

I. General information

NPI: 1811346992
Provider Name (Legal Business Name): MARIA ELENA MOORE BENJAMIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA ELENA MOORE KERN

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 S ORANGE AVE RM G-506
NEWARK NJ
07103-2757
US

IV. Provider business mailing address

555 PRESIDENT ST UNIT 922
BALTIMORE MD
21202-6306
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-5045
  • Fax:
Mailing address:
  • Phone: 860-208-5123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number25MA12041700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: