| Center For Diagnosis And Treatment, Llc | |
|
624 Newark Ave Elizabeth NJ 07208-3539 | |
| (908) 353-3626 | |
| (908) 353-3625 |
| Full Name | Center For Diagnosis And Treatment, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 624 Newark Ave, Elizabeth, New Jersey |
| Authorized Official Name and Position | Luis Marcelo Benalcazar (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9083533626 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Diagnosis And Treatment, Llc 624 Newark Ave Elizabeth NJ 07208-3539 Ph: (908) 353-3626 | Center For Diagnosis And Treatment, Llc 624 Newark Ave Elizabeth NJ 07208-3539 Ph: (908) 353-3626 |
| NPI Number | 1831213693 |
|---|---|
| Provider Enumeration Date | 03/19/2007 |
| Last Update Date | 03/17/2018 |
| Medicare PECOS PAC ID | 1557370129 |
|---|---|
| Medicare Enrollment ID | O20060410000231 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831213693 | NPI | - | NPPES |
| 0028410 | Medicaid | NJ | |
| 0272388 | Medicaid | NJ | |
| 075232U87 | Other | NJ | PHYSICIAN RENDERING NUMBE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 25MA07504600 (New Jersey) | Primary |
| Provider Name | Luis M Benalcazar-puga |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801878269 PECOS PAC ID: 6002719762 Enrollment ID: I20040129000881 |
| Provider Name | Patricia Gonzalez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083156996 PECOS PAC ID: 4385929991 Enrollment ID: I20170322001958 |
| Provider Name | Ada M Andino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609582741 PECOS PAC ID: 8123462181 Enrollment ID: I20240216004341 |
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