Provider Demographics
NPI:1639232671
Name:BENTIVEGNA, MARIE JO (MSN, APN, C)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:JO
Last Name:BENTIVEGNA
Suffix:
Gender:F
Credentials:MSN, APN, C
Other - Prefix:
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Mailing Address - Street 1:PO BOX 22581
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2581
Mailing Address - Country:US
Mailing Address - Phone:610-482-4795
Mailing Address - Fax:856-528-3117
Practice Address - Street 1:200 CAMPBELL DR STE 101
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1067
Practice Address - Country:US
Practice Address - Phone:609-877-8777
Practice Address - Fax:609-877-2497
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00073500163WP2201X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care