Provider Demographics
NPI:1326117078
Name:BENINCASA, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BENINCASA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SHAW ST
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-2614
Mailing Address - Country:US
Mailing Address - Phone:973-478-5550
Mailing Address - Fax:973-478-2290
Practice Address - Street 1:22 SHAW ST
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-2614
Practice Address - Country:US
Practice Address - Phone:973-478-5550
Practice Address - Fax:973-478-2290
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06242100207RA0201X
NJMA062421207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7328508Medicaid
NJ7328508Medicaid
NJ959069Medicare ID - Type Unspecified