Eric Bentolila, M.D. PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

25MA07057600 Issued in NJ

Legal business name

ERIC BENTOLILA, M.D. PA

Practice address

615 Franklin Turnpike
Ridgewood, NJ 07450-0745

Phone

(201) 447-1700

Fax

(201) 447-9386

NPI assigned

Mar 23, 2007

Last updated

Nov 4, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Clarissa Vega

Title

Office Manager

Phone

(973) 874-8459

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572825600000",
    "number": "1245357276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 FRANKLIN AVE",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074503206",
            "telephone_number": "201-447-1700",
            "fax_number": "201-447-9386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 FRANKLIN TURNPIKE",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074500745",
            "telephone_number": "201-447-1700",
            "fax_number": "201-447-9386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERIC BENTOLILA, M.D. PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2019-11-04",
        "status": "A",
        "authorized_official_last_name": "VEGA",
        "authorized_official_first_name": "CLARISSA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "973-874-8459"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA07057600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH GROUP#",
            "identifier": "2371713000",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Ridgewood, NJ
• Providers in Ridgewood, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.