NPIMap

Organization Active NPI

Passaic Pediatrics PA

  • Pediatrics Physician
  • Passaic, NJ
National Provider Identifier
1942384888
Registry record updated Feb 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PASSAIC PEDIATRICS PA
Practice address
298 Passaic Street
Passaic, NJ 07055
Phone
(973) 249-8100
Fax
(973) 249-8110
NPI assigned
Oct 25, 2006
Last updated
Feb 9, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2012

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

Authorized official

Name
Antonio Camilo, MDNPI 1629047048
Title
MD-Owner-President
Phone
(973) 249-8100

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 25MA06599400 NJ
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

298 Passaic Street
Passaic, NJ 07055

Mailing address

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

Other identifiers 6

IdentifierTypeStateIssuer
0044245MedicaidNJ
8407304MedicaidNJ
8220701MedicaidNJ
0117056MedicaidNJ
8407509MedicaidNJ
0044253MedicaidNJ

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
31D1090880Passaic Pediatrics298 Passaic Street, Passaic, NJ 07055Certificate of waiverOct 20, 2026

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.

Locations

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

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": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328745600000",
    "number": "1942384888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "298 PASSAIC STREET",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "07055",
            "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": "298 PASSAIC STREET",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "07055",
            "telephone_number": "973-249-8100",
            "fax_number": "973-249-8110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASSAIC PEDIATRICS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2012-02-09",
        "status": "A",
        "authorized_official_last_name": "CAMILO",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_title_or_position": "MD-OWNER-PRESIDENT",
        "authorized_official_telephone_number": "973-249-8100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA06599400",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0044245",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8407304",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8220701",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0117056",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8407509",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0044253",
            "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 Feb 9, 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.