Provider Demographics
NPI:1003042490
Name:BANERJEE, TRINA DOREEN (MD)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:DOREEN
Last Name:BANERJEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MYERS DRIVE UNIT 105
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-9514
Mailing Address - Country:US
Mailing Address - Phone:856-431-6300
Mailing Address - Fax:856-431-6310
Practice Address - Street 1:5 MYERS DRIVE UNIT 105
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062
Practice Address - Country:US
Practice Address - Phone:856-431-6300
Practice Address - Fax:856-431-6310
Is Sole Proprietor?:No
Enumeration Date:2009-05-31
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08934400207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0474339Medicaid