Provider Demographics
NPI:1801878269
Name:BENALCAZAR, LUIS M (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:M
Last Name:BENALCAZAR
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 1:624 NEWARK AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-3539
Mailing Address - Country:US
Mailing Address - Phone:908-353-3626
Mailing Address - Fax:908-353-3625
Practice Address - Street 1:624 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3539
Practice Address - Country:US
Practice Address - Phone:908-353-3626
Practice Address - Fax:908-353-3625
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2325031207R00000X
NJ25MA07504600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0028410Medicaid
NJ0028410Medicaid
NJ075232Medicare ID - Type Unspecified
NY1350S1Medicare ID - Type UnspecifiedMANHATTAN