Provider Demographics
NPI:1295053171
Name:BENTLEY, WILLIAM EARL IV (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EARL
Last Name:BENTLEY
Suffix:IV
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 STATE ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-3037
Mailing Address - Country:US
Mailing Address - Phone:908-237-0403
Mailing Address - Fax:908-237-9095
Practice Address - Street 1:2100 WESCOTT DR
Practice Address - Street 2:HUNTERDON MEDICAL CTR-ANESTHESIA OFFICE
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4603
Practice Address - Country:US
Practice Address - Phone:908-788-6181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09516200207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
388390NUGMedicare UPIN