Organization
PASSAIC PEDIATRICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTONIO M CAMILO M.D. (OWNER)
(201) 233-3455
Entity
Organization
Contact information
Practice address
200 GREGORY AVE, PASSAIC, NJ 07055-3802
(973) 249-8100
(973) 249-8110
Mailing address
298 PASSAIC ST, PASSAIC, NJ 07055-5813
(973) 249-8100
(973) 249-8110
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MA07167400
NJ
208000000X
Pediatrics Physician
MA07649100
NJ
208000000X
Pediatrics Physician
MA08000400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497724819
—
NJ
05
—
1629047048
—
NJ
05
—
1659418978
—
NJ
Enumeration date
12/06/2012
Last updated
12/06/2012
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