1134229172 NPI number — DR. JAGBIR S BENIWAL MD

Table of content: DR. JAGBIR S BENIWAL MD (NPI 1134229172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134229172 NPI number — DR. JAGBIR S BENIWAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENIWAL
Provider First Name:
JAGBIR
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134229172
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
508 HAMBURG TPKE
Provider Second Line Business Mailing Address:
SUITE 205 BENIWAL MD LLC
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-956-0800
Provider Business Mailing Address Fax Number:
973-956-1885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 HAMBURG TPKE
Provider Second Line Business Practice Location Address:
SUITE 205 BENIWAL MD LLC
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-956-0800
Provider Business Practice Location Address Fax Number:
973-956-1885
Provider Enumeration Date:
09/22/2006

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: 2086S0129X , with the licence number:  MA60489 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6970508 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P430830 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6970508 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: J35036 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0103538 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00009802 . This is a "PALMETTO RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1125433 . This is a "NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3063025 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 91000121202 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: H910001212 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".




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