Healthcare Provider Details

I. General information

NPI: 1659321842
Provider Name (Legal Business Name): FAY L BENNETT-PHILLIPS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 HOW LN SUITE 2B
NORTH BRUNSWICK NJ
08902-4600
US

IV. Provider business mailing address

PO BOX 7184
NORTH BRUNSWICK NJ
08902-7184
US

V. Phone/Fax

Practice location:
  • Phone: 732-249-6164
  • Fax: 732-249-6164
Mailing address:
  • Phone: 732-249-6164
  • Fax: 762-249-6162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA06534600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: