Provider Demographics
NPI:1003817156
Name:BENTON, MARC L (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:L
Last Name:BENTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MADISON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940
Mailing Address - Country:US
Mailing Address - Phone:973-822-2772
Mailing Address - Fax:973-822-2773
Practice Address - Street 1:300 MADISON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940
Practice Address - Country:US
Practice Address - Phone:973-822-2772
Practice Address - Fax:973-822-2773
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05147800207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ121696OtherCHN INS.
NJ222233003004OtherCIGNA
NJ4109289OtherAETNA INS.
NJ263944134OtherHORIZON BLUE CROSS BLUE SHIELD
NJ222233003OtherHORIZON BLUE CROSS
NJ6752022OtherAETNA HMO
NJES253OtherOXFORD
NJ67F351OtherEMPIRE
NJ654757AP7Medicare ID - Type UnspecifiedMEDICARE NUMBER
NJES253OtherOXFORD