Provider Demographics
NPI:1790928273
Name:JANUSZ, ROBERT P (PA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:P
Last Name:JANUSZ
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 4059
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07474-4059
Mailing Address - Country:US
Mailing Address - Phone:973-826-8540
Mailing Address - Fax:855-834-5435
Practice Address - Street 1:145 US HIGHWAY 46
Practice Address - Street 2:SUITE 304
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6830
Practice Address - Country:US
Practice Address - Phone:973-826-8540
Practice Address - Fax:855-834-5435
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00004400363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ352305YP69Medicare PIN