Provider Demographics
NPI:1942787650
Name:BENN, CHRISTINA (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:BENN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 DARROW DR
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-1809
Mailing Address - Country:US
Mailing Address - Phone:609-273-3370
Mailing Address - Fax:
Practice Address - Street 1:16 S JEFFERSON RD
Practice Address - Street 2:
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981-1047
Practice Address - Country:US
Practice Address - Phone:973-325-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003448152W00000X
NJ27OA00694400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ27OA00694400OtherNJ LICENSE