Healthcare Provider Details

I. General information

NPI: 1770796971
Provider Name (Legal Business Name): JENNIFER A BENANTE-HAWKINS MS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N MAIN ST STE 101
CAPE MAY CH NJ
08210-2182
US

IV. Provider business mailing address

108 WYGATE DR
EGG HARBOR TOWNSHIP NJ
08234-5719
US

V. Phone/Fax

Practice location:
  • Phone: 609-465-7557
  • Fax: 609-465-9383
Mailing address:
  • Phone: 609-645-5045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00136900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: