Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | MD001971NJ | NJ |
NPI | 1275535171 |
---|---|
Provider Name | Dr. James A Cancilleri |
First Address | Pleasantville, NJ 08232-2547 |
Second Address | Northfield, NJ 08225-1877 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 29/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U01911 | (02) | NJ |