Individual
BENJAMIN FAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
570 SOUTH AVE E BLDG A, CRANFORD, NJ 07016-3266
(908) 603-4200
(908) 497-1633
Mailing address
1 DIAMOND HILL RD, BERKELEY HEIGHTS, NJ 07922-2104
(908) 273-4300
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
25MA04379500
NJ
208800000X
Urology Physician
Primary
25MA04379500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0563086
AENTA HMO ID #
NJ
01
—
30D141
EMPIRE BC/BS OF NY EDISON
NY
01
—
30D142
EMPIRE BC/BS OF NY OB
NY
01
—
340005179
RR MEDICARE ID #
NJ
01
—
4229622
AETNA PPO ID #
NJ
01
—
5709961
GHI PPO ID #
NJ
01
—
MS186
OXFORD ID #
NJ
Enumeration date
08/15/2006
Last updated
03/09/2022
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