Provider Demographics
NPI:1659651263
Name:BENTIVOGLIO, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BENTIVOGLIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1425
Mailing Address - Country:US
Mailing Address - Phone:732-296-9030
Mailing Address - Fax:
Practice Address - Street 1:10 PLAINFIELD AVE STE 1
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-4077
Practice Address - Country:US
Practice Address - Phone:732-885-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02934200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist