Individual
BRUCE KEVIN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
220 HAMBURG TPKE, WAYNE, NJ 07470-2110
(973) 790-8090
(973) 790-3198
Mailing address
716 BROAD ST, CLIFTON, NJ 07013-1645
(973) 777-1444
(973) 777-4488
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
25MA06066100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790731271
GROUP NPI
NJ
01
—
39114
UNIVERSITY HEALTH PLANS
NJ
05
—
6233007
—
NJ
Enumeration date
07/11/2006
Last updated
07/13/2009
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