1780821629 NPI number — DR. GREGORY STEPHEN JANIS M.D.

Table of content: DR. GREGORY STEPHEN JANIS M.D. (NPI 1780821629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780821629 NPI number — DR. GREGORY STEPHEN JANIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JANIS
Provider First Name:
GREGORY
Provider Middle Name:
STEPHEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780821629
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 95000-4145
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19195-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-376-3180
Provider Business Mailing Address Fax Number:
212-376-3190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 COLUMBUS CIR
Provider Second Line Business Practice Location Address:
3RD FL
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10019-1412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-376-3180
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  235949 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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