NPIMap

Organization Active NPI

Passaic Pediatrics PA

  • Pediatrics Physician
  • Passaic, NJ
National Provider Identifier
1326383076
Registry record updated Dec 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MA07167400 Issued in NJ
Legal business name
PASSAIC PEDIATRICS PA
Practice address
200 Gregory Ave
Passaic, NJ 07055-3802
Phone
(973) 249-8100
Fax
(973) 249-8110
NPI assigned
Dec 6, 2012
Last updated
Dec 6, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Antonio M Camilo, M.D.NPI 1629047048
Title
Owner
Phone
(201) 233-3455

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MA07167400 NJ Primary
Pediatrics Physician 208000000X MA08000400 NJ
Pediatrics Physician 208000000X MA07649100 NJ

Addresses

Primary practice location

200 Gregory Ave
Passaic, NJ 07055-3802

Mailing address

298 Passaic St
Passaic, NJ 07055-5813
Phone (973) 249-8100

Other identifiers 3

IdentifierTypeStateIssuer
1497724819MedicaidNJ
1659418978MedicaidNJ
1629047048MedicaidNJ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D2114833Passaic Pediatrics, PA200 Gregory Avenue, Passaic, NJ 07055Certificate of waiverJun 20, 2028

National Provider Directory

National Provider Directory
Tax ID family
Passaic Pediatrics PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1354752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354752000000",
    "number": "1326383076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "298 PASSAIC ST",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070555813",
            "telephone_number": "973-249-8100",
            "fax_number": "973-249-8110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 GREGORY AVE",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070553802",
            "telephone_number": "973-249-8100",
            "fax_number": "973-249-8110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASSAIC PEDIATRICS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-06",
        "last_updated": "2012-12-06",
        "status": "A",
        "authorized_official_last_name": "CAMILO",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-233-3455",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "MA07167400",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "MA08000400",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "MA07649100",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497724819",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1659418978",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629047048",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Passaic, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.