Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | MA062421 | NJ |
Y | 207RA0201X | Internist - Allergy & Immunology | 25MA06242100 | NJ |
NPI | 1326117078 |
---|---|
Provider Name | Peter Benincasa |
First Address | Garfield, NJ 07026-2614 |
Second Address | Garfield, NJ 07026-2614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 23/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7328508 | (05) | NJ |
G55830 | (02) |