Healthcare Provider Details

I. General information

NPI: 1053706010
Provider Name (Legal Business Name): BENJAMIN LEE MARDER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 S DELSEA DR UNIT C
VINELAND NJ
08360-5308
US

IV. Provider business mailing address

352 S DELSEA DR UNIT C
VINELAND NJ
08360-5308
US

V. Phone/Fax

Practice location:
  • Phone: 856-690-1616
  • Fax: 856-896-6107
Mailing address:
  • Phone: 856-690-1616
  • Fax: 856-896-6107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006669
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00354300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: