Provider Demographics
NPI:1447349162
Name:GITTERMAN, BENJAMIN E (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:E
Last Name:GITTERMAN
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 1:419 N HARRISON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3521
Mailing Address - Country:US
Mailing Address - Phone:609-924-9300
Mailing Address - Fax:609-430-9481
Practice Address - Street 1:419 N HARRISON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3521
Practice Address - Country:US
Practice Address - Phone:609-924-9300
Practice Address - Fax:609-430-9481
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06610600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110167947OtherPALMETTO RAILRD. MEDICARE
NJ7317000Medicaid
NJ815069OtherAETNA HMO PCP
NJ815069OtherAETNA NON HMO PCP
NJ815069OtherAETNA HMO PCP
NJ7317000Medicaid