Provider Demographics
NPI:1811150279
Name:BENAQUISTA DESIPIO, GINA MARIA (DO)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIA
Last Name:BENAQUISTA DESIPIO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:MARIA
Other - Last Name:BENAQUISTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:600 HAVERFORD RD
Mailing Address - Street 2:SUITE G104
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1139
Mailing Address - Country:US
Mailing Address - Phone:610-553-5303
Mailing Address - Fax:610-553-5303
Practice Address - Street 1:118 CONWAY AVE
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2202
Practice Address - Country:US
Practice Address - Phone:610-553-5303
Practice Address - Fax:610-553-5303
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015314208100000X, 2081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine