Provider Demographics
NPI:1760448401
Name:LEIFER, BENNETT (MD)
Entity Type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:
Last Name:LEIFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GODWIN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432
Mailing Address - Country:US
Mailing Address - Phone:201-444-4526
Mailing Address - Fax:201-301-1313
Practice Address - Street 1:301 GODWIN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1544
Practice Address - Country:US
Practice Address - Phone:201-444-4526
Practice Address - Fax:201-301-1313
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA56065207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ757208Medicaid
NJE83238Medicare UPIN
NJ757208Medicaid