Organization
PASSAIC PEDIATRICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTONIO CAMILO MD (MD-OWNER-PRESIDENT)
(973) 249-8100
Entity
Organization
Contact information
Practice address
298 PASSAIC STREET, PASSAIC, NJ 07055
(973) 249-8100
(973) 249-8110
Mailing address
298 PASSAIC STREET, PASSAIC, NJ 07055
(973) 249-8100
(973) 249-8110
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
25MA06599400
NJ
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0044245
—
NJ
05
—
0044253
—
NJ
05
—
0117056
—
NJ
05
—
8220701
—
NJ
05
—
8407304
—
NJ
05
—
8407509
—
NJ
Enumeration date
10/25/2006
Last updated
02/09/2012
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