Provider Demographics
NPI:1518979459
Name:AGUILA, BENJAMIN T (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:T
Last Name:AGUILA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SOCIETY HILL DR N
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-4852
Mailing Address - Country:US
Mailing Address - Phone:201-360-0871
Mailing Address - Fax:
Practice Address - Street 1:2 SOCIETY HILL DR N
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-4852
Practice Address - Country:US
Practice Address - Phone:201-360-0871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA01040400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093675Medicare ID - Type UnspecifiedGROUP NUMBER