Individual
DR. BENJAMIN IRA BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1300 BLACK HORSE PIKE, GLENDORA, NJ 08029-1308
(856) 939-2828
Mailing address
402 LIPPINCOTT DR, MARLTON, NJ 08053-4112
(856) 782-3300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MB06092600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7016905
—
NJ
Enumeration date
11/02/2005
Last updated
09/25/2012
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