Provider Demographics
NPI:1366605545
Name:BENIZZI FAMILY CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:BENIZZI FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-456-1459
Mailing Address - Street 1:1 ERRICKSON CT
Mailing Address - Street 2:
Mailing Address - City:JOBSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08041-2021
Mailing Address - Country:US
Mailing Address - Phone:609-456-1459
Mailing Address - Fax:609-723-0401
Practice Address - Street 1:1 ERRICKSON CT
Practice Address - Street 2:
Practice Address - City:JOBSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08041-2021
Practice Address - Country:US
Practice Address - Phone:609-456-1459
Practice Address - Fax:609-723-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00618900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU75789Medicare UPIN
NJ076745Medicare PIN