Provider Demographics
NPI:1891364071
Name:SCOPELLITE, BENJAMIN (PA-C)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:SCOPELLITE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5727
Mailing Address - Country:US
Mailing Address - Phone:732-741-2313
Mailing Address - Fax:
Practice Address - Street 1:80 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5727
Practice Address - Country:US
Practice Address - Phone:732-741-2313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00628500363A00000X
NJ363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant