Provider Demographics
NPI:1851685291
Name:TAN, BENITO H (MD)
Entity Type:Individual
Prefix:DR
First Name:BENITO
Middle Name:H
Last Name:TAN
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 1:6 MEADOW VIEW RD
Mailing Address - Street 2:
Mailing Address - City:MILLINGON
Mailing Address - State:NJ
Mailing Address - Zip Code:07946-1349
Mailing Address - Country:US
Mailing Address - Phone:908-660-4528
Mailing Address - Fax:
Practice Address - Street 1:6 MEADOW VIEW RD
Practice Address - Street 2:
Practice Address - City:MILLINGON
Practice Address - State:NJ
Practice Address - Zip Code:07946-1349
Practice Address - Country:US
Practice Address - Phone:908-660-4528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA028074002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry