Provider Demographics
NPI:1134472343
Name:BRIAN BENSON MD LLC
Entity Type:Organization
Organization Name:BRIAN BENSON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SICULIETANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-489-6520
Mailing Address - Street 1:20 PROSPECT AVE
Mailing Address - Street 2:SUITE 907
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1997
Mailing Address - Country:US
Mailing Address - Phone:201-996-2750
Mailing Address - Fax:201-489-6530
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:SUITE 907
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1997
Practice Address - Country:US
Practice Address - Phone:201-996-2750
Practice Address - Fax:201-489-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08215300207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty