Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 25MB09586800 | NJ |
NPI | 1003179318 |
---|---|
Provider Name | Dr. William Roderic Bennett |
First Address | Swedesboro, NJ 08085-1276 |
Second Address | Swedesboro, NJ 08085-1276 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2012 |
Last Update Date | 20/03/2017 |