Provider Demographics
NPI:1619061074
Name:BURTON, BENJAMIN MEIR (PT)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:MEIR
Last Name:BURTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:69 NEWARK POMPTON TPKE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457-1426
Mailing Address - Country:US
Mailing Address - Phone:973-248-8111
Mailing Address - Fax:973-248-8113
Practice Address - Street 1:69 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1426
Practice Address - Country:US
Practice Address - Phone:973-248-8111
Practice Address - Fax:973-248-8113
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA006211002251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA00621100OtherLICENSE