Healthcare Provider Details

I. General information

NPI: 1760185318
Provider Name (Legal Business Name): DR. ERICK BENAVIDES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 CHESTNUT RIDGE RD STE 9
WOODCLIFF LAKE NJ
07677-8400
US

IV. Provider business mailing address

200 GRAND ST APT 2
HOBOKEN NJ
07030-2542
US

V. Phone/Fax

Practice location:
  • Phone: 201-571-0900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00392700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: