Healthcare Provider Details

I. General information

NPI: 1336519297
Provider Name (Legal Business Name): RICHARD H. BENGEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2015
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRACE RD STE H
CHERRY HILL NJ
08034-2600
US

IV. Provider business mailing address

115 N EDGMONT ST
MEDIA PA
19063-3013
US

V. Phone/Fax

Practice location:
  • Phone: 856-547-0389
  • Fax:
Mailing address:
  • Phone: 570-977-7902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA057831
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00467400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: