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General NPI Number Information
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NPI Number | 1346297298
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Entity Type | Individual
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Provider Name | ALISA BENSON MODENA M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 101 CARNIE BLVD
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City | VOORHEES
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State | NJ
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Zip | 08043-1548
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Country | US
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Telephone | 856-325-3328
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Fax | 856-325-3276
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Provider Business Mailing Address
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Address Line | 1502 HILLSIDE DR
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City | CHERRY HILL
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State | NJ
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Zip | 08003-3504
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Country | US
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Telephone | 856-429-3149
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 25MA08055000
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License Number State | NJ
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