Healthcare Provider Details

I. General information

NPI: 1487726675
Provider Name (Legal Business Name): ERIC Y. BENTOLILA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 FRANKLIN TURNPIKE
RIDGEWOOD NJ
07450
US

IV. Provider business mailing address

615 FRANKLIN TURNPIKE FIRST FLOOR
RIDGEWOOD NJ
07450
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-1700
  • Fax: 201-447-9386
Mailing address:
  • Phone: 201-447-1700
  • Fax: 201-447-9386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA07057600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: