Provider Demographics
NPI:1487726675
Name:BENTOLILA, ERIC Y (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:Y
Last Name:BENTOLILA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 FRANKLIN TURNPIKE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-447-1700
Mailing Address - Fax:201-447-9386
Practice Address - Street 1:615 FRANKLIN TURNPIKE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-447-1700
Practice Address - Fax:201-447-9386
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07057600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ768D51OtherEMPIRE BCBS
NJ010070576NJ01OtherANTHEM HEALTH #
NJ0864547000OtherAMERIHEALTH #
NJP3602721OtherOXFORD
NJ2K8579OtherHEALTHNET
NJ3839722OtherAETNA HMO
NJ7488147OtherAETNA PPO#
NJ3839722OtherAETNA HMO
NJ2K8579OtherHEALTHNET