Basic Information
| Provider Information | |||||||||
| NPI: | 1912536335 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JANUS | ||||||||
| FirstName: | TREVOR | ||||||||
| MiddleName: | MARK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7978 COUNTY ROAD 501 | ||||||||
| Address2: | |||||||||
| City: | BAYFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 811228756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233632520 | ||||||||
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| Practice Location | |||||||||
| Address1: | 234 E 149TH ST | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104515504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185795000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2020 | ||||||||
| LastUpdateDate: | 04/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146D00000X | Y | Emergency Medical Service Providers | Personal Emergency Response Attendant |
No ID Information.