Provider Demographics
NPI:1548406465
Name:SCHNEIDER, BENJAMIN MARK (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MARK
Last Name:SCHNEIDER
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 1:176 WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6321
Mailing Address - Country:US
Mailing Address - Phone:917-502-9416
Mailing Address - Fax:
Practice Address - Street 1:1811 SPRINGFIELD AVENUE
Practice Address - Street 2:SUMMIT RADIOLOGICAL ASSOCIATES
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974
Practice Address - Country:US
Practice Address - Phone:917-502-9416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA84297002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology