Provider Demographics
NPI:1801989066
Name:PINELAND ASSOCIATES IN OBSTETRICS-GYNECOLOGY,PA
Entity type:Organization
Organization Name:PINELAND ASSOCIATES IN OBSTETRICS-GYNECOLOGY,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BENECKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-458-7878
Mailing Address - Street 1:1608 HIGHWAY 88 WEST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3009
Mailing Address - Country:US
Mailing Address - Phone:732-458-7878
Mailing Address - Fax:732-840-6378
Practice Address - Street 1:1608 HIGHWAY 88 WEST
Practice Address - Street 2:SUITE 208
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3009
Practice Address - Country:US
Practice Address - Phone:732-458-7878
Practice Address - Fax:732-840-6378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02713800207VG0400X
NJ25MA03689200207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2533006Medicaid
NJ1815601Medicaid
NJ2533006Medicaid
NJ1815601Medicaid
C63177Medicare UPIN
191030095Medicare ID - Type Unspecified