Healthcare Provider Details

I. General information

NPI: 1326117078
Provider Name (Legal Business Name): PETER BENINCASA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 SHAW ST
GARFIELD NJ
07026-2614
US

IV. Provider business mailing address

22 SHAW ST
GARFIELD NJ
07026-2614
US

V. Phone/Fax

Practice location:
  • Phone: 973-478-5550
  • Fax: 973-478-2290
Mailing address:
  • Phone: 973-478-5550
  • Fax: 973-478-2290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number25MA06242100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMA062421
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: