Provider Demographics
NPI:1356533970
Name:BENTON, JULIE L
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:L
Last Name:BENTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1334
Mailing Address - Country:US
Mailing Address - Phone:551-265-8027
Mailing Address - Fax:
Practice Address - Street 1:315 E NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4896
Practice Address - Country:US
Practice Address - Phone:973-436-1780
Practice Address - Fax:908-673-7157
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN156361363LA2200X
NJ26NJ00283100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA642321603AMedicaid
GA642321603EMedicaid
GA642321603BMedicaid
GA642321603DMedicaid
GA642321603CMedicaid