Healthcare Provider Details

I. General information

NPI: 1578881884
Provider Name (Legal Business Name): JAY ROBERT BENSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 EWING ST STE B17
PRINCETON NJ
08540-2755
US

IV. Provider business mailing address

601 EWING ST STE B17
PRINCETON NJ
08540-2755
US

V. Phone/Fax

Practice location:
  • Phone: 609-200-6077
  • Fax: 609-772-4882
Mailing address:
  • Phone: 609-200-6077
  • Fax: 609-772-4882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB08672300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: