Provider Demographics
NPI:1457419657
Name:JANIGA, EDWARD (OD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:JANIGA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-1962
Mailing Address - Country:US
Mailing Address - Phone:973-423-2015
Mailing Address - Fax:973-423-5192
Practice Address - Street 1:274 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-1962
Practice Address - Country:US
Practice Address - Phone:973-423-2015
Practice Address - Fax:973-423-5192
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4761152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ627484Medicare PIN