Provider Demographics
NPI:1659321842
Name:BENNETT-PHILLIPS, FAY L (MD)
Entity Type:Individual
Prefix:DR
First Name:FAY
Middle Name:L
Last Name:BENNETT-PHILLIPS
Suffix:
Gender:F
Credentials:MD
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 7184
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-7184
Mailing Address - Country:US
Mailing Address - Phone:732-249-6164
Mailing Address - Fax:762-249-6162
Practice Address - Street 1:1440 HOW LN
Practice Address - Street 2:SUITE 2B
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-4600
Practice Address - Country:US
Practice Address - Phone:732-249-6164
Practice Address - Fax:732-249-6164
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06534600207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7384106Medicaid
NJ017263Medicare ID - Type Unspecified
NJ7384106Medicaid