Provider Demographics
NPI:1497022867
Name:BENAOJAN, EDMUND
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:
Last Name:BENAOJAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 5TH AVE
Mailing Address - Street 2:SUITE 1204
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6107
Mailing Address - Country:US
Mailing Address - Phone:646-998-8128
Mailing Address - Fax:646-998-8038
Practice Address - Street 1:905 STATE ROUTE 10
Practice Address - Street 2:
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981-1181
Practice Address - Country:US
Practice Address - Phone:914-631-9020
Practice Address - Fax:914-631-9028
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034179225100000X
NJ40QA01437500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist