Provider Demographics
NPI:1609180439
Name:BENSON, CARLA (DPM)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 NEWTON SPARTA RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2812
Mailing Address - Country:US
Mailing Address - Phone:973-383-3115
Mailing Address - Fax:
Practice Address - Street 1:125 NEWTON SPARTA RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2812
Practice Address - Country:US
Practice Address - Phone:973-383-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD08305600213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist