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NPI Code Detail

MEDICARE: DR. LANE J BENOFF MD

MEDICARE: DR. LANE J BENOFF MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0000XCardiovascular Disease Physician25MA07780300NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1222970871OTHERNJTAX ID#

General Provider Information

NPI Number : 1073581997
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LANE J BENOFF MD
Provider Business Mailing Address
First Line : 777 TERRACE AVE
Second Line : 3RD FLOOR
City : HASBROUCK HEIGHTS
State : NJ
Zip : 07604-3110
Country : US
Telephone Number : 201-288-4252
Fax Number : 201-288-7172
Provider Business Practice Location Address
First Line : 777 TERRACE AVE
Second Line : 3RD FLOOR
City : HASBROUCK HEIGHTS
State : NJ
Zip : 07604-3110
Country : US
Telephone Number : 201-288-4252
Fax Number : 201-288-7172
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2006
Last Update Date : 08/25/2008

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