Healthcare Provider Details

I. General information

NPI: 1316854037
Provider Name (Legal Business Name): LISA ADEL BENJAMIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PARSONAGE RD STE 118
EDISON NJ
08837-2429
US

IV. Provider business mailing address

2 LEGACY PL UNIT 103
EAST BRUNSWICK NJ
08816-1000
US

V. Phone/Fax

Practice location:
  • Phone: 732-494-9400
  • Fax:
Mailing address:
  • Phone: 347-889-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP01050600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: