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General NPI Number Information
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NPI Number | 1861592586
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Entity Type | Individual
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Provider Name | ROBERT JOSEPH DIBENEDETTO MD
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Gender | Male
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Dates
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Enumeration Date | 09/23/2006
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Last Update Date | 07/26/2017
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Provider Practice Location Address
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Address Line | 23 CRESTFIELD RD
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City | BOONTON
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State | NJ
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Zip | 07005-9007
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Country | US
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Telephone | 973-216-6049
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Fax |
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Provider Business Mailing Address
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Address Line | 23 CRESTFIELD RD.
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City | BOONTON TOWNSHIP
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State | NJ
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Zip | 07005
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Country | US
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Telephone | 973-216-6049
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25MA02906200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MA02906200
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License Number State | NJ
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