Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 25MB05997100 | NJ |
Y | 208600000X | Surgeon | 25MB05997100 | NJ |
NPI | 1013954205 |
---|---|
Provider Name | Mary Ann Benigno |
First Address | Ridgewood, NJ 07450 |
Second Address | Ridgewood, NJ 07450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F70381 | (02) |