Provider Demographics
NPI:1134229172
Name:BENIWAL, JAGBIR S (MD)
Entity type:Individual
Prefix:DR
First Name:JAGBIR
Middle Name:S
Last Name:BENIWAL
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 1:508 HAMBURG TPKE
Mailing Address - Street 2:SUITE 205 BENIWAL MD LLC
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-956-0800
Mailing Address - Fax:973-956-1885
Practice Address - Street 1:508 HAMBURG TPKE
Practice Address - Street 2:SUITE 205 BENIWAL MD LLC
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-956-0800
Practice Address - Fax:973-956-1885
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA604892086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6970508Medicaid
P430830OtherOXFORD
6970508OtherAMERIGROUP
J35036OtherHEALTHNET
0103538OtherGHI
P00009802OtherPALMETTO RR MEDICARE
1125433OtherNJ HEALTH
3063025OtherAETNA
91000121202OtherAMERICHOICE
H910001212OtherAMERIHEALTH
6970508OtherAMERIGROUP
91000121202OtherAMERICHOICE
0103538Medicare UPIN