Provider Demographics
NPI:1962727644
Name:VAN BOXTEL, BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:VAN BOXTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MID-ATLANTIC SURGICAL ASSOCIATES
Mailing Address - Street 2:100 MADISON AVENUE
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960
Mailing Address - Country:US
Mailing Address - Phone:973-971-7300
Mailing Address - Fax:973-984-7019
Practice Address - Street 1:MID-ATLANTIC SURGICAL ASSOCIATES
Practice Address - Street 2:100 MADISON AVENUE
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960
Practice Address - Country:US
Practice Address - Phone:973-971-7300
Practice Address - Fax:973-984-7019
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA10509400208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program