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General NPI Number Information
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NPI Number | 1659499010
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Entity Type | Individual
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Provider Name | CAMILA KRYSICKA JANNIGER M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 42 LOCUST AVE
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City | WALLINGTON
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State | NJ
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Zip | 07057-1300
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Country | US
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Telephone | 973-472-5044
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Fax | 973-472-4235
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Provider Business Mailing Address
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Address Line | 100 GLENWOOD RD
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-1951
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Country | US
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Telephone | 201-569-0046
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MA 51201
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A51591
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License Number State | CA
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