Basic Information
| Provider Information | |||||||||
| NPI: | 1134232291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAND | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 DIAMOND HILL RD | ||||||||
| Address2: | |||||||||
| City: | BERKELEY HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079222104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082734300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 570 SOUTH AVE E BLDG A | ||||||||
| Address2: | |||||||||
| City: | CRANFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070163266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086034200 | ||||||||
| FaxNumber: | 9084971633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 03/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 25MA04379500 | NJ | N | Other Service Providers | Specialist | 208800000X | 25MA04379500 | NJ | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 0563086 | 01 | NJ | AENTA HMO ID # | OTHER | 30D142 | 01 | NY | EMPIRE BC/BS OF NY OB | OTHER | 340005179 | 01 | NJ | RR MEDICARE ID # | OTHER | 4229622 | 01 | NJ | AETNA PPO ID # | OTHER | 5709961 | 01 | NJ | GHI PPO ID # | OTHER | MS186 | 01 | NJ | OXFORD ID # | OTHER | 30D141 | 01 | NY | EMPIRE BC/BS OF NY EDISON | OTHER |