Provider Demographics
NPI:1336312420
Name:BENSON, BRIAN ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ERIC
Last Name:BENSON
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 1:20 PROSPECT AVE
Mailing Address - Street 2:SUITE 613
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1997
Mailing Address - Country:US
Mailing Address - Phone:551-996-2750
Mailing Address - Fax:551-228-7606
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:SUITE 613
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1997
Practice Address - Country:US
Practice Address - Phone:551-996-2750
Practice Address - Fax:551-228-7606
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08215300207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1134472343OtherNPI
NJ260149OtherPTAN