Provider Demographics
NPI:1669502035
Name:ASIEGBU, BENEDICT E (MD)
Entity Type:Individual
Prefix:
First Name:BENEDICT
Middle Name:E
Last Name:ASIEGBU
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 1:100 E PENN SQ
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9234
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:65 W JIMMIE LEEDS RD
Practice Address - Street 2:CHOP CARE NETWORK @ ATLANTICARE
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240-9102
Practice Address - Country:US
Practice Address - Phone:609-652-1000
Practice Address - Fax:302-651-4945
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA082549002080N0001X
PAMD4318372080N0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019782330001Medicaid
PA1019782330002Medicaid
NJ0136549Medicaid