Individual
BENJAMIN FAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
1719 MAIN STREET, LAKE COMO, NJ 07719
(732) 894-9200
Mailing address
16 OVERHILL ROAD, EAST BRUNSWICK, NJ 08816
(732) 543-4413
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA01655100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40QA01655100
LICENSE#: 40QA01655100
NJ
Enumeration date
03/21/2016
Last updated
03/21/2016
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