Provider Demographics
NPI:1639232671
Name:BENTIVEGNA, MARIE JO (MSN, APN, C)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:JO
Last Name:BENTIVEGNA
Suffix:
Gender:F
Credentials:MSN, APN, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22581
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2581
Mailing Address - Country:US
Mailing Address - Phone:610-482-4795
Mailing Address - Fax:856-528-3117
Practice Address - Street 1:220 SUNSET RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1126
Practice Address - Country:US
Practice Address - Phone:609-877-8777
Practice Address - Fax:609-877-2497
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00073500163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care