Individual
BENJAMIN MARVIN EVANS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
RN APN-C
Contact information
Practice address
155 JEFFERSON ST, MENTAL HEALTH-4W, NEWARK, NJ 07105-1706
(973) 465-2605
(973) 465-2829
Mailing address
224 EGE AVE, JERSEY CITY, NJ 07304-1413
(201) 333-1094
(201) 333-6226
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
26NC07677700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6741100
—
NJ
Enumeration date
12/05/2005
Last updated
07/08/2007
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