Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 25MA08055000 | NJ |
NPI | 1346297298 |
---|---|
Provider Name | Dr. Alisa Benson Modena |
First Address | Cherry Hill, NJ 08003-3504 |
Second Address | Voorhees, NJ 08043-1548 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 08/03/2021 |