Provider Demographics
NPI:1154351724
Name:BENETT, JODI A (DO)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:A
Last Name:BENETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 ROUTE 70 EAST
Mailing Address - Street 2:SUITE S-93
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-4208
Mailing Address - Country:US
Mailing Address - Phone:856-424-8091
Mailing Address - Fax:856-424-0704
Practice Address - Street 1:1930 STATE HWY 70 E STE S93
Practice Address - Street 2:EXECUTIVE MEWS
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-4208
Practice Address - Country:US
Practice Address - Phone:856-424-8091
Practice Address - Fax:856-424-0704
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05291400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5229804Medicaid
NJ5229804Medicaid
NJ717151Medicare ID - Type UnspecifiedMEDICARE