Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 25MA03689200 | NJ |
NPI | 1003895418 |
---|---|
Provider Name | Theresa Renee Benecki |
First Address | Brick, NJ 08724-3009 |
Second Address | Brick, NJ 08724-3009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 13/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2533006 | (05) | NJ |
C63177 | (02) |