Provider Demographics
NPI:1982712865
Name:BENCOSME, PABLO (M D)
Entity Type:Individual
Prefix:DR
First Name:PABLO
Middle Name:
Last Name:BENCOSME
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 RECTOR ST
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4434
Mailing Address - Country:US
Mailing Address - Phone:732-442-5710
Mailing Address - Fax:
Practice Address - Street 1:188 MARKET ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4328
Practice Address - Country:US
Practice Address - Phone:732-442-4251
Practice Address - Fax:732-442-1787
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA37429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3091902Medicaid
NJC56289Medicare UPIN
NJ3091902Medicaid