Provider Demographics
NPI:1538556691
Name:BENEDETTO SPORTS AND ORTHOPEDICS
Entity type:Organization
Organization Name:BENEDETTO SPORTS AND ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEDETTO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS, SCS
Authorized Official - Phone:201-988-2806
Mailing Address - Street 1:326 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-3315
Mailing Address - Country:US
Mailing Address - Phone:201-988-2806
Mailing Address - Fax:
Practice Address - Street 1:575 RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07031-4823
Practice Address - Country:US
Practice Address - Phone:201-988-2806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01285700261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy