Healthcare Provider Details

I. General information

NPI: 1326235441
Provider Name (Legal Business Name): ELZBIETA GODLEWSKA-JANUSZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELZBIETA GODLEWSKA-JANUSZ MD

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2177 OAK TREE RD SUITE 207
EDISON NJ
08820-1082
US

IV. Provider business mailing address

2177 OAK TREE RD SUITE 207
EDISON NJ
08820-1082
US

V. Phone/Fax

Practice location:
  • Phone: 732-549-7007
  • Fax:
Mailing address:
  • Phone: 732-549-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08293300
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: