Healthcare Provider Details

I. General information

NPI: 1760655468
Provider Name (Legal Business Name): JAMAL CAMILO JANANIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14789 ROUTE 31
ALBION NY
14411-9709
US

IV. Provider business mailing address

14789 ROUTE 31
ALBION NY
14411-9709
US

V. Phone/Fax

Practice location:
  • Phone: 585-589-2273
  • Fax: 585-589-1876
Mailing address:
  • Phone: 585-589-2273
  • Fax: 585-589-1876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME101159
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number255326-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: