Provider Demographics
NPI:1356324693
Name:MARTY, BENITO I (MD)
Entity Type:Individual
Prefix:DR
First Name:BENITO
Middle Name:I
Last Name:MARTY
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 1:572 LENAPE CIR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1141
Mailing Address - Country:US
Mailing Address - Phone:215-860-3146
Mailing Address - Fax:
Practice Address - Street 1:572 LENAPE CIR
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1141
Practice Address - Country:US
Practice Address - Phone:215-860-3146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063096L2084P0800X
NJMA658992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJBM0221110Medicare PIN
PA119159Medicare PIN