Provider Demographics
NPI:1891804654
Name:CHOUAKE, BENJAMIN (MD)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:CHOUAKE
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:PO BOX 1546
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-0546
Mailing Address - Country:US
Mailing Address - Phone:201-917-2246
Mailing Address - Fax:201-917-2276
Practice Address - Street 1:663 PALISADE AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010
Practice Address - Country:US
Practice Address - Phone:201-917-2246
Practice Address - Fax:201-917-2276
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04032000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0923605Medicaid
NJ27A041OtherEMPIRE NY
NJ505147OtherUS HEALTHCARE
NJ424728Medicare PIN
NJ505147OtherUS HEALTHCARE