Healthcare Provider Details

I. General information

NPI: 1275535171
Provider Name (Legal Business Name): JAMES A CANCILLERI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 TILTON RD
NORTHFIELD NJ
08225-1877
US

IV. Provider business mailing address

22 N FRANKLIN BLVD
PLEASANTVILLE NJ
08232-2547
US

V. Phone/Fax

Practice location:
  • Phone: 609-241-8664
  • Fax: 609-415-2323
Mailing address:
  • Phone: 609-272-0655
  • Fax: 609-272-9317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberMD001971NJ
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: