Provider Demographics
NPI:1104972199
Name:JANIA, CANDACE (LAC, FABORM)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:JANIA
Suffix:
Gender:F
Credentials:LAC, FABORM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:LIBERTY CORNER
Mailing Address - State:NJ
Mailing Address - Zip Code:07938-0200
Mailing Address - Country:US
Mailing Address - Phone:908-719-1362
Mailing Address - Fax:
Practice Address - Street 1:14 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920
Practice Address - Country:US
Practice Address - Phone:908-719-1362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00044200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ20-5203194OtherTAX ID #