Healthcare Provider Details

I. General information

NPI: 1487519187
Provider Name (Legal Business Name): LAURA LUCIA BENEGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 OLD HIGHWAY 22
CLINTON NJ
08809-1389
US

IV. Provider business mailing address

115 SOMERSET ST
SOMERVILLE NJ
08876-2814
US

V. Phone/Fax

Practice location:
  • Phone: 908-730-6363
  • Fax:
Mailing address:
  • Phone: 908-625-0878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number25MP00983800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MP00983800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: