Provider Demographics
NPI:1780734962
Name:DISPENZIERE, BENJAMIN R (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:R
Last Name:DISPENZIERE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43 YAWPO AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-2714
Mailing Address - Country:US
Mailing Address - Phone:201-337-7201
Mailing Address - Fax:201-337-9621
Practice Address - Street 1:43 YAWPO AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-2714
Practice Address - Country:US
Practice Address - Phone:201-337-7201
Practice Address - Fax:201-337-9621
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03741600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC55352Medicare UPIN
NJ315332WC0Medicare PIN