Provider Demographics
NPI:1013129824
Name:BENJAMIN D LESSIG DO PA
Entity Type:Organization
Organization Name:BENJAMIN D LESSIG DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LESSIG
Authorized Official - Suffix:
Authorized Official - Credentials:DO PA
Authorized Official - Phone:732-281-3590
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:732-281-3590
Mailing Address - Fax:732-281-0054
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:732-281-3590
Practice Address - Fax:732-281-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD66440207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG65685Medicare UPIN
NJ122420Medicare PIN