Provider Demographics
NPI:1760477061
Name:LESSIG, BENJAMIN DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DAVID
Last Name:LESSIG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 COMMONS WAY
Mailing Address - Street 2:BLDG B
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6427
Mailing Address - Country:US
Mailing Address - Phone:732-281-2700
Mailing Address - Fax:
Practice Address - Street 1:212 COMMONS WAY
Practice Address - Street 2:BLDG B
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6427
Practice Address - Country:US
Practice Address - Phone:732-281-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB66440207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7591209Medicaid
NJ122420Medicare PIN
NJG65685Medicare UPIN