Provider Demographics
NPI:1114047792
Name:BENTIVEGNA, JOSEPH P (MSN,APN,C,CEN)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:P
Last Name:BENTIVEGNA
Suffix:
Gender:M
Credentials:MSN,APN,C,CEN
Other - Prefix:
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Mailing Address - Street 1:1 MEDICAL CENTER BLVD
Mailing Address - Street 2:ACP # 233
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3902
Mailing Address - Country:US
Mailing Address - Phone:610-447-7605
Mailing Address - Fax:610-447-6088
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:ACP # 233
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-447-7605
Practice Address - Fax:610-447-6088
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00110200363LA2100X
PASP008899363LA2100X
PARN569452163W00000X
NJ26NO12037000163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse