Provider Demographics
NPI:1912536335
Name:JANUS, TREVOR MARK
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:MARK
Last Name:JANUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7978 COUNTY ROAD 501
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-8756
Mailing Address - Country:US
Mailing Address - Phone:323-363-2520
Mailing Address - Fax:
Practice Address - Street 1:3045 EAST AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036-2611
Practice Address - Country:US
Practice Address - Phone:315-668-5240
Practice Address - Fax:315-668-5242
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146D00000X
NY327488207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant