Provider Demographics
NPI:1629073572
Name:BENOFF, KEITH RICHARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:RICHARD
Last Name:BENOFF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 PALISADE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632
Mailing Address - Country:US
Mailing Address - Phone:201-568-3412
Mailing Address - Fax:201-568-8249
Practice Address - Street 1:700 PALISADE AVENUE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632
Practice Address - Country:US
Practice Address - Phone:201-568-3412
Practice Address - Fax:201-568-8249
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00415100174400000X
NJ35S100415100103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No174400000XOther Service ProvidersSpecialist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist