Provider Demographics
NPI:1821013350
Name:BENSON, DOUGLAS (PT)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:BENSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 MORRIS TPKE STE 301
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-2634
Mailing Address - Country:US
Mailing Address - Phone:973-467-4444
Mailing Address - Fax:973-467-4446
Practice Address - Street 1:788 MORRIS TPKE STE 301
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-2634
Practice Address - Country:US
Practice Address - Phone:973-467-4444
Practice Address - Fax:973-467-4446
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA 09158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ085273 DBDMedicare ID - Type Unspecified