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General NPI Number Information
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NPI Number | 1417168105
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Entity Type | Individual
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Provider Name | MICHAEL JOHN JANECZKO MD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3401 CIVIC CENTER BLVD CHILDREN'S HOSPITAL OF PHILADELPHIA - NEONATOLOGY
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4319
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Country | US
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Telephone | 215-829-3191
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Fax | 215-829-7123
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Provider Business Mailing Address
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Address Line | 101 E OLNEY AVE STE 400
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City | PHILADELPHIA
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State | PA
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Zip | 19120-2470
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Country | US
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Telephone | 215-456-1825
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Fax | 215-456-5926
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | C10010611
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | MD431490
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License Number State | PA
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