Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 25MA10638900 | NJ |
N | 207X00000X | Orthopaedic Surgeon | A154107 | CA |
NPI | 1023350113 |
---|---|
Provider Name | Dr. Bensen Benjamin Fan |
First Address | Boston, MA 02241-6457 |
Second Address | Morristown, NJ 07960-7337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2013 |
Last Update Date | 11/12/2019 |