Provider Demographics
NPI:1467604843
Name:DE LA ROSA, BENJAMIN DANNY (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DANNY
Last Name:DE LA ROSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07653-1325
Mailing Address - Country:US
Mailing Address - Phone:201-591-9840
Mailing Address - Fax:201-591-9837
Practice Address - Street 1:197 CEDAR LN
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4317
Practice Address - Country:US
Practice Address - Phone:201-591-9840
Practice Address - Fax:201-591-9837
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08927900207RI0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease