Individual
MADISON RILEY BENNERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
730 LACEY RD STE 8, FORKED RIVER, NJ 08731-1300
(732) 977-6240
Mailing address
730 LACEY RD STE 8, FORKED RIVER, NJ 08731-1300
(732) 977-6240
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00877800
NJ
363A00000X
Physician Assistant
—
—
Other
Enumeration date
07/30/2024
Last updated
03/21/2025
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