Individual
BRIAN J. JANICEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1 HEALTHY WAY, OCEANSIDE, NY 11572-1551
(516) 632-3900
Mailing address
PO BOX 826223, PHILADELPHIA, PA 19182-6223
(866) 898-7142
(770) 237-1723
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005690-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02082722
—
NY
Enumeration date
12/21/2005
Last updated
05/13/2008
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