Provider Demographics
NPI:1174108633
Name:BENSTEIN, IRA (MS, ED)
Entity type:Individual
Prefix:MR
First Name:IRA
Middle Name:
Last Name:BENSTEIN
Suffix:
Gender:M
Credentials:MS, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 STEEPLECHASE CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-2217
Mailing Address - Country:US
Mailing Address - Phone:732-905-9452
Mailing Address - Fax:
Practice Address - Street 1:1200 RIVER AVE STE 9G
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5657
Practice Address - Country:US
Practice Address - Phone:844-458-0196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities