1710921101 NPI number — DR. ELIZABETH COCH BENSTOCK MD

Table of content: DR. ELIZABETH COCH BENSTOCK MD (NPI 1710921101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710921101 NPI number — DR. ELIZABETH COCH BENSTOCK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COCH BENSTOCK
Provider First Name:
ELIZABETH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BENSTOCK
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1710921101
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3501 W CHESTER PIKE
Provider Second Line Business Mailing Address:
UNIT 205
Provider Business Mailing Address City Name:
NEWTOWN SQUARE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19073-3704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-325-5553
Provider Business Mailing Address Fax Number:
610-325-5532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 W CHESTER PIKE
Provider Second Line Business Practice Location Address:
UNIT 205
Provider Business Practice Location Address City Name:
NEWTOWN SQUARE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19073-3704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-325-5553
Provider Business Practice Location Address Fax Number:
610-325-5532
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  MD070523L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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